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目的探讨2型糖尿病肾病患者血清血管紧张素转换酶(ACE)检测的临床意义。方法选择2型糖尿病患者(DM)301例和健康体检者291例,根据尿微量白蛋白/肌酐比值(UACR)将DM患者分为正常白蛋白尿组、微量白蛋白尿组、大量白蛋白尿组,分析血清ACE、肾功能指标,绘制ROC曲线分析血清ACE对微量和大量白蛋白尿的诊断价值,并对大量白蛋白尿发生的危险因素进行多因素Logistic回归分析。结果 2型糖尿病患者血清ACE活性显著高于正常对照组,差异有统计学意义(t=-6.703,P<0.01)。无白蛋白尿组与微量白蛋白尿组之间ACE活性差异无统计学意义(P>0.05),而大量白蛋白尿组显著高于其他组,差异有统计学意义(P<0.05)。血清ACE诊断微量白蛋白尿和大量白蛋白尿的AUC分别为0.649(0.595~0.707)和0.680(0.608~0.750),P<0.001,后者优于前者。多因素Logistic回归分析,结果显示血清ACE和Cr为糖尿病患者发生大量白蛋白尿的独立危险因素。结论血清ACE活性与2型糖尿病肾病有比较密切的关系,血清ACE高活性可能是肾病发展到后期的危险标志。
Objective To investigate the clinical significance of detecting serum angiotensin-converting enzyme (ACE) in patients with type 2 diabetic nephropathy. Methods A total of 301 DM patients and 291 healthy subjects were enrolled in this study. According to the urinary albumin / creatinine ratio (UACR), DM patients were divided into normal albuminuria group, microalbuminuria group, The serum ACE and renal function indexes were analyzed. The ROC curve was drawn to analyze the diagnostic value of serum ACE on micro and macroalbuminuria. Multivariate logistic regression analysis was performed on the risk factors of massive albuminuria. Results Serum ACE activity in type 2 diabetic patients was significantly higher than that in normal controls (t = -6.703, P <0.01). There was no significant difference in ACE activity between albuminuria group and microalbuminuria group (P> 0.05), while the albuminuria group was significantly higher than the other groups (P <0.05). The AUC of serum ACE for the diagnosis of microalbuminuria and mass albuminuria were 0.649 (0.595-0.707) and 0.680 (0.608-0.750) respectively, P <0.001, which was better than the former. Multivariate Logistic regression analysis showed that serum ACE and Cr were independent risk factors for developing massive albuminuria in diabetic patients. Conclusions Serum ACE activity is closely related to type 2 diabetic nephropathy. Serum ACE high activity may be a risk marker for the development of nephropathy.