miR-146a、UAER等指标联合检测对早期2型糖尿病肾脏病临床诊断的应用价值

The Clinical Diagnostic Value of Combined Detection of miR-146a, UAER, and Other Indicators for Early-Stage Type 2 Diabetic Nephropathy

摘要: 目的：探讨血清miR-146a、SLPI、IGFBP7、TIMP-2对早期糖尿病肾病(DN)的诊断价值。方法：选取2022年1月至2023年12月在杭州市富阳区第一人民医院就诊的临床诊断为T2DM患者192例，按24 h尿微量清蛋白排泄率(24 h UAER)分为糖尿病肾脏病患者(DN) 48例(A组)，早期糖尿病肾病患者48例(B组)，糖尿病无肾脏病患者48例(C组)，另外选取同期健康体检者作为对照组48例(D组)。检测四组患者血清miR-146a、SLPI、IGFBP7、TIMP-2及24h UAER表达水平，并分析其对早期DN的诊断价值。结果：A组患者血清中miR-146a水平显著高于B、C、D组 (p < 0.05)，A组血清中SLPI、TIMP-2、IGFBP7指标显著低于B、C、D组(p < 0.05)，血清五个分子指标仅miR-146a、UAER单项诊断DN患者AUC面积分别为0.623、0.801 (p < 0.05)，同时小样本金标准诊断对比，miR-146a、UAER单项诊断DN患者AUC面积分别为0.643、0.850 (p < 0.05)，SLPI、TIMP-2、IGFBP7诊断DN患者AUC面积分别为0.464、0.586、0.425 (p < 0.05)，最终我们分析所有样本中五个分子联合诊断DN患者AUC面积为0.903 (p < 0.05)。结论：miR-146a检测对早期DN具有诊断价值，可作为糖尿病肾损伤早期的评估指标，miR-146a、SLPI、IGFBP7、TIMP-2联合UAER检测对早期DN具有更高的诊断价值。

Abstract: Objective: To explore the diagnostic value of serum miR-146a, SLPI, IGFBP7, and TIMP-2 for early diabetic nephropathy (DN). Methods: A total of 192 patients clinically diagnosed with type 2 diabetes mellitus (T2DM) from January 2022 to December 2024 at the Fuyang District First People’s Hospital in Hangzhou were selected. Based on the 24-hour urinary albumin excretion rate (24 h UAER), the patients were divided into three groups: DN patients (48 cases, Group A), early DN patients (48 cases, Group B), and diabetes patients without kidney disease (48 cases, Group C). Additionally, 48 healthy individuals undergoing routine health check-ups during the same period were selected as the control group (Group D). The expression levels of serum miR-146a, SLPI, IGFBP7, TIMP-2, and 24 h UAER were measured in all four groups, and their diagnostic value for early DN was analyzed. Results: The serum miR-146a levels in Group A were significantly higher than those in Groups B, C, and D (p < 0.05). The indicators SLPI, TIMP-2, and IGFBP7 in Group A were significantly lower than those in Groups B, C, and D (p < 0.05). The diagnostic AUC areas of miR-146a and UAER for DN in Group A were 0.623 and 0.801, respectively (p < 0.05). With small sample gold standard diagnostics, the AUC areas for miR-146a and UAER were 0.643 and 0.850, respectively (p < 0.05). The AUC areas for SLPI, TIMP-2, and IGFBP7 were 0.464, 0.586, and 0.425, respectively (p < 0.05). Ultimately, the combined diagnostic AUC area for the five molecular markers in DN was 0.903 (p < 0.05). Conclusion: miR-146a testing has diagnostic value for early DN and can serve as an early assessment marker for diabetic kidney damage. The combination of miR-146a, SLPI, IGFBP7, and TIMP-2 with UAER provides higher diagnostic value for early DN.