Effective evaluation of combined blood and urine biochemical tests for early diagnosis of diabetic nephropathy
血液联合尿液生化检验应用于糖尿病肾病早期诊断的有效评价

摘要

目的 系统评价血液与尿液生化指标联合检测对糖尿病肾病（DN）早期诊断的应用价值。方法 选取2型糖尿病患者186例，依据指南分为单纯糖尿病组（DM组，92例）与早期糖尿病肾病组（EDN组，94例），并设健康对照组（NC组，90例）。检测所有对象的空腹血糖、糖化血红蛋白、血清胱抑素C（Cys C）、同型半胱氨酸（Hcy）、尿微量白蛋白及尿α1-微球蛋白等指标，计算尿白蛋白/肌酐比值（UACR）。比较各组指标差异，并分析不同检测方案的诊断效能。结果 EDN组患者的血清Cys C、Hcy及尿UACR等指标水平均高于DM组与NC组。联合应用血清Cys C、Hcy与UACR进行诊断时，其敏感性与特异性都高于任何单项指标检测。与传统的单一UACR检测相比，联合检测方案的诊断符合率从84.9%提升至93.5%。结论 联合血液与尿液生化指标能够更全面、灵敏地识别早期糖尿病肾病，其诊断效能优于单项检测，具有重要的临床推广价值。

Abstract

Objective To systematically evaluate the application value of combined detection of blood and urine biochemical indicators in the early diagnosis of diabetic nephropathy (DN).
Methods A total of 186 patients with type 2 diabetes were selected and divided into a simple diabetes group (DM group, 92 cases) and an early diabetic nephropathy group (EDN group, 94 cases) according to guidelines, with a healthy control group (NC group, 90 cases) also established. Fasting blood glucose, glycated hemoglobin, serum cystatin C (Cys C), homocysteine (Hcy), urinary microalbumin, urinary α1-microglobulin, and other indicators were measured in all subjects, and the urine albumin-to-creatinine ratio (UACR) was calculated. Differences in indicators among the groups were compared, and the diagnostic efficacy of different detection schemes was analyzed.
Results The levels of serum Cys C, Hcy, and urinary UACR in the EDN group were higher than those in the DM group and the NC group. When serum Cys C, Hcy, and UACR were used in combination for diagnosis, both sensitivity and specificity were higher than those of any single indicator. Compared with the traditional single UACR detection, the diagnostic accuracy of the combined detection scheme increased from 84.9% to 93.5%.
Conclusion   The combination of blood and urine biochemical indicators can more comprehensively and sensitively identify early diabetic nephropathy. Its diagnostic efficacy is superior to that of single indicator detection, demonstrating significant clinical value.