ROC曲线评价尿微量白蛋白和血清Cystatin C在2型糖尿病早期肾损伤中的诊断价值

目的 应用ROC曲线(relative operating characteristic)评价尿微量白蛋白(mAlb)及Cystatin C在糖尿病肾病的早期诊断价值.方法 对152例尿常规检查蛋白阴性的糖尿病患者应用单光子发射计算机断层摄影显像技术行肾动态显像和肾小球滤过率检查,并与尿微量白蛋白及Cystatin C行ROC分析.结果 Cystatin C临界点取1.3 mg/L时ROC曲线下面积0.893,敏感性78.26%,特异性84.9%,阳性似然比5.17,阴性似然比0.52,Youden指数0.736,比数积52.41.尿微量白蛋白临界点取15.6 mg/L时,ROC曲线下面积0.681,敏感性60.87%,特异性79.2%,阳性似然比3.23,阴性似然比0.27,Youden指数0.564,比数积46.38.结论 血清Cystatin C较尿微量白蛋白在2型糖尿病肾病早期损伤诊断中有更好的灵敏性和特异性.

The diagnosis value of urinary micro-albumin and serum Cystatin C at early impairment stage of diabetic nephropathy with relative operating characteristic curve

Objective To evaluate diagnosis value of urinary micro-albumin and serum Cystatin C at early impairment stage of diabetic nephropathy with relative operating characteristic curve.Methods GFRs were detected in 152 diabetics with negative routine uric protein by Single Photon Emission Computed Tomography(SPECT),and inhaled technetium-99m diethylenetriaminepentaacetic acid(99mTc-DTPA)was used as tracer reagent in SPECT.Results of urinary micro-albumins and serum Cystatin C were examined in these patients.Then ROC analysis was carried between the two indexes.Results When critical value of serum Cystatin C was 1.3mg/L,the area below ROC curve was 0.893,sensitivity and specificity were 78.26% and 84.9% respectively,positive Likelihood ratio was 5.17,negitive Likelihood ratio was 0.52,Youden index was 0.736,and odd product was 52.41.When critical value of micro-albumin was15.6mg/L,the down area of ROC curve was 0.681 sensitivity and specificity were 60.8% and 79.2% respectively,positive Likelihood ratio was 3.23,negitive Likelihood ratio was 0.27,Youden index was 0.564,and odd product was 46.38.Conclusion Serum Cystatin C is more sensitive and specific than urine mAlb in diagnosis at early impairment stage of diabetic nephropathy.