摘要
目的分析尿液中铁调素在不同分期2型糖尿病肾病(diabetic kidney disease,DKD)患者中的表达水平及其与DKD及相关指标的关系。方法选择上海健康医学院附属周浦医院2022年6月至2023年12月内分泌科住院2型糖尿病患者139例为研究对象。DKD分期通过尿微量白蛋白/尿肌酐比值(urinary albumin/creatinine ratio,UACR)判定:A1期为UACR<30 mg/g,A2期DKD为UACR≥30 mg/g~≤300 mg/g,A3期DKD为UACR>300 mg/g。按照DKD分期进行分组,其中A1期患者50例(A1组),A2期DKD患者47例(A2组),A3期DKD患者42例(A3组)。采用酶联免疫吸附测定法测定尿铁调素,同时检测空腹血糖、总胆固醇、甘油三酯、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、血肌酐及糖化血红蛋白(hemoglobin A1c,HbA1c)并进行比较,分析尿铁调素与其他指标的相关性、DKD风险因素及诊断价值的评价。呈正态分布的计量资料以x^(-)±s表示,3组间均数比较,若方差齐性,采用方差分析检验;若方差不齐,采用韦尔奇检验;计数资料组间构成比或率采用χ^(2)检验;相关性分析采用Pearson相关性分析;多因素分析采用二元Logistic回归模型;采用受试者特征曲线分析尿铁调素在诊断DKD中的价值。结果A1组尿铁调素为(5.3±1.0)μg/L,A2组为(7.7±2.5)μg/L,A3组为(10.1±2.7)μg/L,3组间差异有统计学意义(F=58.92,P<0.001),并且随DKD严重程度增加而增高;尿铁调素与UACR(r=0.684,P<0.001)、血肌酐(r=0.590,P<0.001)、病程(r=0.485,P<0.001)、甘油三酯(r=0.264,P=0.002)、年龄(r=0.235,P=0.005)、总胆固醇(r=0.224,P=0.008)及收缩压(r=0.194,P=0.022)呈正相关,与肾小球滤过率(r=-0.540,P<0.001)、BMI(r=-0.175,P=0.040)呈负相关;与空腹血糖、HbA1c、ALT及舒张压无相关性(均P>0.05)。其次,通过二元Logistic回归分析提示尿铁调素水平的升高是DKD发生的风险因素(OR=4.147,95%CI:2.154~7.984,P<0.001)。通过受试者特征曲线分析显示尿铁调素最佳诊断切点为6.35μg/L,此时
ObjectiveTo analyze the expression level of hepcidin in urine of patients with type 2 diabetic kidney disease(DKD)in different stages and its relationship with DKD and related indicators.MethodsFrom June 2022 to December 2023,139 inpatients with type 2 diabetes mellitus in the Department of Endocrinology,Zhoupu Hospital Affiliated to Shanghai Health Medical College were selected as the research objects.The stage of DKD was judged by urinary albumin/creatinine ratio(UACR):UACR<30 mg/g in stage A1,UACR≥30 mg/g~≤300 mg/g in stage A2.DKD in stage A3 was UACR>300 mg/g.According to the stage of DKD,there were 50 patients with stage A1(group A1),47 patients with stage A2(group A2),and 42 patients with stage A3(group A3).Urinary hepcidin was determined by enzyme-linked immunosorbent assay,and fasting blood glucose,total cholesterol,triglyceride,alanine aminotransferase(ALT),serum creatinine and hemoglobin A1c(HbA1c)were measured and compared.The correlation between urinary hepcidin and other markers,the risk factors of DKD and the evaluation of diagnostic value were analyzed.Measurement data with normal distribution were expressed as x^(-)±s,mean comparison among the three groups,if the variance was homogeneous,the analysis of variance test was used;if the variance was not homogeneous,the Welch test was used;the proportion or rate of enumeration data among the groups was tested byχ^(2) test;Pearson correlation analysis was used for correlation analysis;binary Logistic regression model was used for multivariate analysis;The value of urinary hepcidin in the diagnosis of DKD was analyzed by receiver operating characteristic curve.ResultsUrinary hepcidin was(5.3±1.0)μg/L in group A1,(7.7±2.5)μg/L in group A2,and(10.1±2.7)μg/L in group A3.There was significant difference among the three groups(F=58.92,P<0.001),and urinary hepcidin increased with the severity of DKD;Urinary Hepcidin was related to UACR(R=0.684,P<0.001),serum creatinine(R=0.590,P<0.001),course of disease(R=0.485,P<0.001),triglyceride(R=0.264,P=0.002
作者
慕开达
张进安
张菁
杨燕萍
杨晓荣
李广欣
杨志远
Mu Kaida;Zhang Jin'an;Zhang Jing;Yang Yanping;Yang Xiaorong;Li Guangxin;Yang Zhiyuan(Department of Endocrinology,Zhoupu Hospital Affiliated to Shanghai Health Medical College,Shanghai 201318,China;Shanghai Jinshan District Center for Disease Control and Prevention,Shanghai 201599,China)
出处
《中国综合临床》
2024年第4期265-270,共6页
Clinical Medicine of China
基金
上海市卫生健康委员会科研项目(20214Y0353)
上海市浦东新区卫生健康委员会优秀青年医学人才培养项目(PWRq2021-27)
上海市浦东新区卫生健康委员会卫生科技项目(PWZxk2022-22)。
关键词
糖尿病肾病
铁调素
2型糖尿病
尿液
诊断
Diabetic nephropathy
Hepcidin
Type 2 diabetes mellitus
Urine
Diagnosis
