Clinical application of serum neutrophil gelatinase-associated lipocalin combined with cystatin C, blood creatinine, urea nitrogen and urine neutrophil gelatinase-associated lipocalin in the diagnosis of early diabetic nephropathy in elderly patients
10.3760/cma.j.issn.0254-9026.2025.05.004
- VernacularTitle:血清中性粒细胞明胶酶相关脂质运载蛋白及胱抑素C 血肌酐 尿素氮 尿中性粒细胞明胶酶相关脂质运载蛋白联合诊断老年早期糖尿病肾病的临床应用
- Author:
Lijuan WANG
1
;
Meng WANG
1
;
Qiangyi WANG
1
;
Qian ZHANG
1
;
Wensong LIU
1
Author Information
1. 北京医院检验科 国家老年医学中心 中国医学科学院老年医学研究院，北京 100730
- Publication Type:Journal Article
- Keywords:
Diabetic nephropathy;
Urea nitrogen;
Cystatin C;
Neutrophil gelatinase-associated Lipocalin;
Creatinine
- From:
Chinese Journal of Geriatrics
2025;44(5):590-596
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical application value of cystatin C(CysC), neutrophil gelatinase-associated lipocalin(NGAL), urea nitrogen(UREA), blood creatinine(Scr)and urinary neutrophil gelatinase-associated lipocalin(NGAL)in early diabetic nephropathy and their relationship with aging.Methods:A total of 140 diabetic patients aged 60 and above who were admitted to Beijing Hospital from July 2022 to November 2022 and 59 healthy people aged 60 and above who underwent physical examination in Beijing hospital during the same period were selected as the study subjects.In January 2023, 157 healthy people over 20 years old who underwent physical examination in Beijing Hospital were used as another group of research objects to explore the relationship between various indicators and aging.According to the urinary microalbumin/urinary creatinine(UACR)ratio, the patients were divided into three groups: 40 patients with simple diabetes mellitus(DM), 57 patients with early diabetic nephropathy(EDN), and 43 patients with diabetic nephropathy(DN).59 healthy subjects were used as control group(NC group).Serum NGAL, Scr, Cys C, UREA and urinary NGAL were detected, and NGAL was determined by latex immunoturbidimetry.Scr was determined by sarcosine oxidase method.Cys C was determined by immunoturbidimetry.Urease-glutamate dehydrogenase method was used to determine UREA.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of urea alone and combined diagnosis in EDN.The relationship between serum NGAL, Scr, Cys C, UREA and urinary NGAL and gender and aging were analyzed in 157 healthy individuals.Results:Compared to the NC group, serum NGAL, Scr, CysC, and UREA levels were significantly higher in the EDN and DN groups(all P<0.01), and the differences between EDN group, DN group and NC group were statistically significant( P<0.01).The values of these markers increased across the NC, DM, EDN, and DN groups.ROC curve shows: The area under curve(AUC)of serum NGAL, Scr, Cys C, UREA, urine NGAL, combined diagnosis 1 and combined diagnosis 2 were 0.655, 0.760, 0.789, 0.753, 0.628, 0.831, 0.827, respectively.The sensitivity of combined diagnosis 1 and combined diagnosis 2 was higher(63.2% and 66.7%), and the specificity of serum NGAL was higher(96.6%).The AUC values of Cys C, co-diagnosis 1, and co-diagnosis 2 were large and correlated(AUC=0.789, 0.831, 0.827, rs=0.501, 0.573, 0.567), and the diagnostic value of Cys C, co-diagnosis 1, and co-diagnosis 2 for EDN was high(AUC=0.789, 0.831, 0.827, Yoden index=0.442, 0.530, 0.531; sensitivity 56.1%, 63.2%, 66.7%; specificity 88.1%, 89.8%, 86.4%).Healthy individuals over 20 years of age: serum NGAL[(127.5±35.5)μg/L vs.(111.5±32.4)μg/L, P=0.004], Scr[(83.4±11.2)μmol/L versus(63.4±11.0)μmol/L, P<0.001], Cys C[(0.8±0.2)mg/L vs.(0.7±0.2)mg/L, P<0.001], and UREA levels were higher in males than females[(5.1±1.1)mmol/L vs.(4.6±1.1)mmol/ L, P=0.002]; urinary NGAL was higher in females than males[22.0(13.0, 37.8)μg/L vs.15.0(10.0, 30.5)μg/L, P=0.025].Cys C( F=16.582, P<0.001), urinary NGAL levels( F=-3.533, P<0.001)basically increased with age. Conclusions:CysC showed a higher diagnostic value for EDN than UREA, Scr, blood NGAL, and urine NGAL in patients aged 60 and above Combined diagnosis 1 and combined diagnosis 2 have higher value in monitoring the progress of DN.The levels of Cys C and urinary NGAL showed a gradually increasing trend with the increase of age, and the levels of serum NGAL, Scr, Cys C and UREA were higher in males than in females.Urinary NGAL was higher in females than males.
