2022 年第 6 期 第 17 卷

血清总胆红素联合中性粒细胞明胶酶相关脂质运载蛋白对2型糖尿病肾病患者病情发展的预测价值

Predictive value of serum total bilirubin combined with neutrophil gelatinase-associated lipocalin in disease development of patients with type 2 diabetic nephropathy 

作者：陈筱涛1刘韵1龙碧莹1曹昊2

英文作者：Chen Xiaotao1 Liu Yun1 Long Biying1 Cao Hao2

单位：1湘南学院附属医院内分泌科，郴州423000；2湘南学院临床医学系，郴州423000

英文单位：1Department of Endocrinology Affiliated Hospital of Xiangnan University Chenzhou 423000 China; 2Department of Clinical Medicine Xiangnan University Chenzhou 423000 China

关键词：2型糖尿病肾病；血清总胆红素；中性粒细胞明胶酶相关脂质运载蛋白

英文关键词：Type2diabeticnephropathy;Serumtotalbilirubin;Neutrophilgelatinase-associatedlipocalin

• 摘要：

• 目的 探讨血清总胆红素联合中性粒细胞明胶酶相关脂质运载蛋白（NGAL）对2型糖尿病肾病患者病情发展的预测价值。方法 选择2021年1—7月湘南学院附属医院收治的150例2型糖尿病肾病患者为研究对象。入院后完成24 h尿白蛋白排泄率（UAER）测定，根据测定结果分为尿蛋白正常组（63例，UAER≤20 mg/24 h）、微量蛋白尿组（59例，UAER>20～<300 mg/24 h）和大量蛋白尿组（28例，UAER≥300 mg/24 h）。比较各组患者基线资料及相关实验室检查指标，分析血清总胆红素、NGAL与生化指标的相关性。结果 大量蛋白尿组血清总胆红素水平低于尿蛋白正常组及微量蛋白尿组、且微量蛋白尿组低于尿蛋白正常组，而大量蛋白尿组血NGAL、尿NGAL、血尿素氮、血肌酐、胱抑素C水平高于尿蛋白正常组及微量蛋白尿组、且微量蛋白尿组高于尿蛋白正常组，差异均有统计学意义（均P＜0.01）。Pearson相关性分析结果表明，2型糖尿病肾病患者血清总胆红素水平与血尿素氮、血肌酐、胱抑素C水平均呈负相关，血NGAL、尿NGAL水平与上述指标水平均呈正相关（均P＜0.01）。以血清总胆红素、血NGAL、尿NGAL、血清总胆红素+血NGAL+尿NGAL对2型糖尿病肾病患者病情发展进行预测，敏感度分别为79.2%、76.1%、77.4%、80.6%，特异度分别为76.1%、75.6%、74.6%、82.2%。校准曲线结果显示，平均偏离量为0.017，预测值与实际观测值较为一致。结论 2型糖尿病肾病患者不同临床阶段血清总胆红素、血NGAL、尿NGAL水平存在变化，血清总胆红素联合NGAL对患者病情发展有预测价值。

• Objective To discuss the predictive value of serum total bilirubin (TB) combined with neutrophil gelatinase-associated lipocalin (NGAL) in disease development of patients with type 2 diabetic nephropathy. Methods Totally 150 patients with type 2 diabetic nephropathy who were admitted to Affiliated Hospital of Xiangnan University from January to July 2021 were selected. After admission, 24 h urinary albumin excretion rate (UAER) was measured. According to the level of UAER, patients were divided into normal urinary protein group (63 cases, UAER≤20 mg/24 h), micro proteinuria group (59 cases, UAER>20-<300 mg/24 h) and massive proteinuria group (28 cases, UAER≥300 mg/24 h). The baseline data and related laboratory indexes were compared among the groups, and the correlation among serum TB, NGAL and biochemical indexes was analyzed. Results   Serum level of TB in massive proteinuria group was lower than that in normal urine protein group and micro proteinuria group, and the level in micro proteinuria group was lower than that in normal urine protein group; the levels of blood NGAL, urinary NGAL, blood urea nitrogen, blood creatinine and cystatin C in massive proteinuria group were higher than those in normal urine protein group and microa proteinuria group, and the levels in microa proteinuria group were higher than those in normal urine protein group (all P<0.01). Pearson correlation analysis showed that serum level of TB was negatively correlated with levels of blood urea nitrogen, serum creatinine and cystatin C, while levels of blood NGAL and urine NGAL were positively correlated with above indexes in patients with type 2 diabetic nephropathy(all P<0.01). Serum TB, blood NGAL, urine NGAL, and serum total bilirubin+blood NGAL+urine NGAL were used to predict the progression of type 2 diabetic nephropathy. The sensitivity was 79.2%, 76.1%, 77.4% and 80.6%, and the specificity was 76.1%, 75.6%, 74.6% and 82.2%, respectively. The calibration curve showed that the average deviation is 0.017, and the predicted value was consistent with the actual observation value. Conclusions  The levels of serum TB, blood NGAL and urine NGAL change in different stages of type 2 diabetic nephropathy. Serum TB combined with NGAL has a predictive value for the development of patients.