糖化血红蛋白，尿白蛋白，肾小球滤过率联合 检验在糖尿病肾病诊断中的价值

The Value of Combined Testing for Glycated Hemoglobin, Urinary Albumin, and Glomerular Filtration Rate in the Diagnosis of Diabetic Nephropathy

摘要: 目的：探讨糖化血红蛋白(HbA1c)、尿白蛋白(UAlb)与肾小球滤过率(GFR)三项指标联合检测在糖尿病肾病(DN)诊断中的应用价值。方法：选取本院于2024年12月至2026年1月期间收治的49例DN患者纳入DN组，同期选取在本院接受治疗且未合并肾脏并发症的单纯糖尿病患者49例作为非DN组。以肾穿刺病理结果为金标准，对比分析两组间HbA1c、UAlb、eGFR水平差异；分别评估单项指标(HbA1c、UAlb、GFR)及三项联合检测对DN的诊断效能，包括灵敏度、特异度、准确度、阳性预测值(PPV)和阴性预测值(NPV)。结果：DN组患者HbA1c、UAlb水平显著高于非DN组；DN组GFR水平则显著低于非DN组(P < 0.05)；以肾穿刺病理结果为金标准，结果显示，当采用HbA1c、UAlb及GFR三项指标联合检测时，其诊断效能得到显著高于单一指标检查，灵敏度、特异度、准确度分别高达97.96%、93.88%和95.92%，阳性预测值与阴性预测值亦分别达到94.12%和97.87%，具有显著的统计学意义(P < 0.05)。结论：HbA1c、UAlb与GFR联合检测可显著提高糖尿病肾病的诊断效能，其灵敏度、特异度和准确度均优于单一指标检测，为DN的早期识别与干预提供了更可靠的实验室依据。

Abstract: Objective: To explore the application value of combined detection of three indicators—glycated hemoglobin (HbA1c), urinary albumin (UAlb), and glomerular filtration rate (GFR)—in the diagnosis of diabetic nephropathy (DN). Methods: A total of 49 DN patients admitted to our hospital from December 2024 to January 2026 were included in the DN group, while 49 non-DN patients with diabetes but no renal complications were selected as the non-DN group during the same period. Renal biopsy pathology results served as the gold standard to compare the differences in HbA1c, UAlb, and eGFR levels between the two groups. The diagnostic efficacy of individual indicators (HbA1c, UAlb, GFR) and the combined detection of the three indicators for DN was evaluated, including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Results: The levels of HbA1c and UAlb were significantly higher in the DN group than in the non-DN group, while the GFR level was significantly lower in the DN group (P < 0.05). Using renal biopsy pathology results as the gold standard, the results showed that combined detection of HbA1c, UAlb, and GFR significantly improved diagnostic efficacy compared to single-indicator testing, with sensitivity, specificity, and accuracy reaching 97.96%, 93.88%, and 95.92%, respectively. The positive and negative predictive values also reached 94.12% and 97.87%, respectively, showing significant statistical significance (P < 0.05). Conclusion: Combined detection of HbA1c, UAlb, and GFR significantly enhances the diagnostic efficacy of diabetic nephropathy, with sensitivity, specificity, and accuracy surpassing those of single-indicator testing, providing a more reliable laboratory basis for early identification and intervention of DN.