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目的 探讨尿肾损伤分子-1(KIM-1)、尿调节素（UMOD）、微量白蛋白（mAlb）联合评估糖尿病早期肾损伤患者肾功能快速下降的价值。方法 选取2021年7月至2023年7月收治的糖尿病早期肾损伤患者160例作为研究对象，随访1年，根据肾功能是否快速下降分为观察组和对照组。比较2组一般资料及入院当天尿KIM-1、UMOD、mAlb水平，采用多因素logistic回归方程筛选出患者肾功能快速下降的影响因素，采用受试者工作特征（ROC）曲线分析各指标预测患者肾功能快速下降的价值，采用相对危险度评价各指标对患者肾功能快速下降的影响。结果 观察组入院当天糖化血红蛋白、血尿素、血肌酐及尿KIM-1、mAlb水平均高于对照组，UMOD水平低于对照组（P<0.01）；校正相关因素后，多因素logistic回归分析显示尿KIM-1、mAlb、UMOD仍是糖尿病早期肾损伤患者肾功能快速下降的影响因素（P<0.05）；尿KIM-1+UMOD+mAlb联合预测糖尿病早期肾损伤患者肾功能快速下降的曲线下面积为0.939，优于各指标单独及两两指标联合预测；尿KIM-1、mAlb高值和UMOD低值患者发生肾功能快速下降的风险分别是尿KIM-1、mAlb低值和UMOD高值患者的5.000倍、7.690倍、3.667倍。结论 尿KIM-1、UMOD、mAlb均是糖尿病早期肾损伤患者肾功能快速下降的独立影响因素，联合检测对患者肾功能快速下降具有良好的预测价值，可作为患者肾功能快速下降的潜在预测指标，并可指导临床决策。
Abstract：Objective To explore the value of combined detection of urinary kidney injury molecule-1(KIM-1), urinary modulin(UMOD), and microalbumin(mAlb) in assessing the rapid decline in renal function of patients with early diabetic kidney damage. Methods A total of 160 patients with early diabetic kidney damage from July 2021 to July 2023 were selected as the research subjects and followed up for one year. They were categorized into an observation group and a control group based on whether their renal function declined rapidly. The general information of the two groups and the levels of urinary KIM-1, UMOD,and mAlb on the day of admission were compared. Multivariate Logistic regression equations were used to screen the influencing factors of rapid decline in renal function of patients. Receiver operating characteristic(ROC) curve analysis was used to evaluate the predictive value of each indicator for rapid decline in renal function. The impact of each indicator on the rapid decline in renal function was assessed using risk assessment. Results On the day of admission, the observation group had higher levels of glycosylated hemoglobin, blood urea, serum creatinine, urinary KIM-1, and mAlb than the control group, while the expression level of UMOD was lower(P<0.01). After adjusting for relevant factors, multivariate logistic regression analysis showed that urinary KIM-1, mAlb, and UMOD remained influencing factors for rapid decline in renal function(P<0.05). The area under the curve of KIM-1+UMOD+mAlb for predicting rapid decline in renal function was 0.939, which was superior to the predictive value of each indicator alone and in combination. The risk of rapid decline in renal function for patients with high values of KIM-1, mAlb, and low values of UMOD was 5.000 times, 7.690 times, and 3.667 times higher, respectively, than those in patients with low values of KIM-1, mAlb, and high values of UMOD. Conclusion Urinary KIM-1, UMOD, and mAlb are all independent factors influencing the rapid decline in renal function ofn patients with early diabetic kidney damage. Combined detection has good predictive value for the rapid decline in renal function of patients, can be used as a potential predictor of the rapid decline in renal function of patients,and can guide clinical decision-making.
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基本信息:
DOI：
中图分类号:R692.9;R587.2
引用信息:
[1]白伟娜,李坤,马莉.尿KIM-1、UMOD、mAlb联合评估糖尿病早期肾损伤患者肾功能快速下降的价值[J].临床误诊误治,2025,38(11):24-29.
基金信息:
2024年度中医药类科学研究课题计划项目（2024139）