摘要
目的分析老年糖尿病肾脏疾病(diabetic kidney disease,DKD)患者营养指标及巨噬细胞极化状态变化与肾损伤程度的关系。方法选取2020年1月至2021年10月在宝鸡市第二人民医院进行治疗的老年DKD患者110例,据慢性肾脏病(chronic kidney diseases,CKD)分期标准,分为Ⅰ期组(n=22)、Ⅱ期组(n=23)、Ⅲ期组(n=28)、Ⅳ期组(n=20)、Ⅴ期组(n=17),另选取同期收治的单纯老年糖尿病患者30例作为对照组。采用双抗体夹心酶联免疫吸附实验分别检测所有研究对象外周血M1、M2型巨噬细胞表型标志物一氧化氮合酶(inducible nitric oxide synthase,iNOS)蛋白及甘露糖受体(mannose receptor,MR)水平,均行肾小球滤过率(glomerular filtration rate,GFR)检查,采用全自动生化分析仪检测营养指标[白蛋白(albumin,Alb)、总蛋白(total protein,TP)、转铁蛋白(transferrin,TRF)],酶联免疫吸附法检测肾功能相关指标[血尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,Scr)、尿β2-微球蛋白(β2-microglobulin,β2-MG)],炎症指标[白细胞介素6(interleukin-6,IL-6)],比较各组以上指标检测结果,Pearson相关性分析营养指标及巨噬细胞极化状态变化与肾功能指标及估算肾小球滤过率(estimated glomerular filtration rate,eGFR)的关系,采用受试者工作特征曲线分析营养指标及巨噬细胞极化状态变化评估老年DKD患者肾损伤情况的应用价值。结果不同分期组eGFR、Alb、TP、TRF及MR均明显较对照组低,iNOS蛋白较对照组高,且Ⅰ~Ⅴ期组eGFR、Alb、TP、TRF呈下降趋势(P<0.05);Ⅱ期组MR值较Ⅰ期、Ⅲ期、Ⅳ期及Ⅴ期组低,且iNOS蛋白水平较Ⅰ期、Ⅲ期、Ⅳ期及Ⅴ期组高(P<0.05);不同分期组IL-6、BUN、Scr、β2-MG均明显较对照组高,且Ⅰ期组IL-6、BUN、Scr、β2-MG均明显较Ⅱ期、Ⅲ期、Ⅳ期及Ⅴ期组低(P<0.05);Pearson相关性分析显示,DKD患者Alb、TP、TRF及MR与eGFR呈正相关性,与肾功能指标BUN、Scr、β2-MG呈负相关�
Objective To examine the relationship between nutritional parameters,macrophagic polarization changes and severity of renal injury in elders with diabetic kidney disease(DKD).Methods Between January 2020 and October 2021,a total of 110 DKD elders were hospitalized.According to the staging criteria of chronic kidney disease(CKD),they were divided into five groups of stageⅠ(n=22),stageⅡ(n=23),stageⅢ(n=28),stageⅣ(n=20)and stageⅤ(n=17).A total of 30 elders with diabetes mellitus during the same period were recruited as control group.The levels of M1 and M2 macrophage phenotypic markers[nitric oxide synthase(iNOS)&mannose receptor(MR)]in peripheral blood were detected by double-antibody sandwich enzyme-linked immunosorbent assay(ELISA).Estimated glomerular filtration rate(eGFR)was assayed.The nutritional parameters[albumin(Alb),total protein(TP)&transferrin(TRF)]were detected by a full-automatic biochemical analyzer.Renal functionrelated parameters[blood urea nitrogen(BUN),serum creatinine(Scr)&β2-microglobulin(β2-MG)]and inflammatory parameter[interleukin(IL)-6]were detected by ELISA.The detection results of the above parameters in different groups were compared.The relationship between nutritional parameters,macrophagic polarization changes,renal function parameters and eGFR was analyzed by Pearson’s correlation analysis.And the evaluation value of nutritional parameters and macrophagic polarization for renal injury was analyzed by receiver operating characteristic(ROC)curve.Results eGFR,Alb,TP,TRF and MR in different staging groups were significantly lower than those in control group.And iNOS protein was higher than that in control group.In stages I-V groups,eGFR,Alb,TP and TRF gradually declined(P<0.05).MR value was lower in stageⅡgroup than that in stagesⅠ,Ⅲ,ⅣandⅤgroups while iNOS protein was higher than that in the other groups(P<0.05).IL-6,BUN,Scr andβ2-MG in different staging groups were significantly higher than those in control group and it was significantly lower in stage I group th
作者
王丽琼
白小岗
Wang Li-qiong;Bai Xiao-gang(Department of Endocrinology,Second Municipal People's Hospital,Baoji 721000,China;Department of Endocrinology,Affiliated Hospital,Yan'an University,Yan'an 716099,China)
出处
《临床肾脏病杂志》
2022年第12期1023-1029,共7页
Journal Of Clinical Nephrology
基金
陕西省社会发展科技攻关基金资助项目(2016SF-112)。
关键词
糖尿病肾脏疾病
营养指标
巨噬细胞极化
肾损伤
Diabetic kidney disease
Nutritional parameter
Macrophagic polarization
Renal injury
