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目的应用受试者工作特征曲线(ROC)评价尿Ⅳ型胶原和尿层粘连蛋白(LN)在糖尿病肾病(DN)监测中的临床价值。方法 143例病程大于5年的T2DM患者和103名正常对照用放射免疫法测定晨尿Ⅳ型胶原和尿LN水平,分析正常白蛋白尿的T2DM患者尿Ⅳ型胶原和尿LN的变化和ROC曲线下面积等。结果正常尿白蛋白组和微量尿白蛋白组的T2DM患者晨尿Ⅳ型胶原和尿LN水平均显著高于正常对照组(P<0.05);尿Ⅳ型胶原>18.9 ng/mL和尿LN>130.33 ng/mL为正常参考范围上限;正常尿白蛋白的T2DM患者以晨尿Alb=16 mg/L为分界值时,尿Ⅳ型胶原曲线下面积(0.749)超过Alb/Cr面积(0.698)、尿Ⅳ型胶原和尿LN水平有显著变化(P<0.05)。结论病程大于5年的正常尿白蛋白T2DM患者晨尿Ⅳ型胶原>18.9 ng/ml或和尿LN>130.33 ng/ml时,应高度怀疑早期DN。
Objective To evaluate the clinical value of urinary type Ⅳ collagen and urinary laminin (LN) in the monitoring of diabetic nephropathy (DN) using receiver operating characteristic curve (ROC). Methods 143 cases of T2DM patients with a disease duration of more than 5 years and 103 normal controls were used to determine the level of type Ⅳ collagen and urinary LN in morning urine by radioimmunoassay. The changes of urinary type Ⅳ collagen and urine LN and ROC curve were analyzed in T2DM patients with normal albuminuria Under the area and so on. Results The levels of type Ⅳ collagen and urinary LN in morning urine in normal urine albumin group and microalbuminuria group were significantly higher than those in normal control group (P <0.05). Urinary type Ⅳ collagen> 18.9 ng / mL and urinary LN> 130.33 ng / mL was the upper limit of the normal reference range. The area under curve of urinary type Ⅳ collagen (0.749) exceeded the Alb / Cr area (0.698) when urine albumin was stored at Alb = 16 mg / Urine type Ⅳ collagen and urine LN levels were significantly changed (P <0.05). Conclusions Early urinary albumin T2DM patients with early onset DN> 18.9 ng / ml or urinary LN> 130.33 ng / ml should have a high suspicion of early DN.