摘要
目的探讨糖尿病肾病(DN)患者血清脂质运载蛋白-2(LCN-2)、血小板反应蛋白-2(TSP-2)水平与肾功能及预后的相关性。方法选取2018年1月—2020年12月中国人民解放军空军军医大学第一附属医院内分泌科收治的DN患者155例为DN组,同期单纯T2DM患者70例为单纯T2DM组,同期体检健康者70例为健康对照组,根据随访3年预后将DN患者分为不良预后亚组38例和良好预后亚组117例。检测血清LCN-2、TSP-2水平和肾功能指标[估计肾小球滤过率(eGFR)、尿白蛋白肌酐比(UACR)];采用Pearson法分析DN患者血清LCN-2、TSP-2水平与肾功能指标的相关性;Logistic回归模型分析DN患者不良预后的因素;绘制受试者工作特征(ROC)曲线评价血清LCN-2、TSP-2水平对DN患者不良预后的预测价值。结果健康对照组、单纯T2DM组、DN组血清LCN-2、TSP-2水平和UACR依次升高,eGFR依次降低(F/P=48.365/<0.001、57.480/<0.001、218.946/<0.001、253.488/<0.001);155例DN患者3年不良预后发生率为24.52%(38/155);与良好预后亚组比较,不良预后亚组血清LCN-2、TSP-2、UACR水平升高,eGFR降低(t/P=7.057/<0.001、6.457/<0.001、4.967/<0.001、5.398/<0.001);DN患者血清LCN-2、TSP-2水平与eGFR呈负相关(r/P=-0.745/<0.001、-0.731/<0.001),与UACR呈正相关(r/P=0.703/<0.001、0.691/<0.001);多因素Logistic回归显示,慢性肾脏病4期、糖化血红蛋白高、UACR高、LCN-2高、TSP-2高为DN患者不良预后的独立危险因素[OR(95%CI)=3.972(1.121~14.076)、1.640(1.024~2.628)、1.015(1.002~1.030)、1.016(1.005~1.027)、1.196(1.077~1.328)],eGFR高为独立保护因素[OR(95%CI)=0.959(0.924~0.994)];血清LCN-2、TSP-2水平及二者联合预测DN患者不良预后的曲线下面积(AUC)分别为0.795、0.783、0.882,二者联合的AUC大于血清LCN-2、TSP-2水平单独预测(Z/P=3.200/0.001、2.680/0.007)。结论DN患者血清LCN-2、TSP-2水平升高与肾功能及不良预后密切相关,血清LCN-2联合TSP-2水平预测DN患者预后的价值较�
Objective To investigate the correlation between serum lipocalin 2(LCN-2),thrombospondin 2(TSP-2)levels and renal function and prognosis in patients with diabetes nephropathy(DN).Methods One hundred and fifty-five DN patients admitted to the Endocrinology Department of the First Affiliated Hospital of the Chinese People's Liberation Army Air Force Medical University from January 2018 to December 2020 were selected as the DN group,70 simple T2DM patients during the same period were selected as the simple T2DM group,and 70 healthy individuals during the same period were selected as the healthy control group.Based on the 3-year prognosis,DN patients were divided into 38 poor prognosis subgroups and 117 good prognosis subgroups.Serum LCN-2 and TSP-2 levels and renal function indicators were detected[estimated glomerular filtration rate(eGFR),urinary albumin creatinine ratio(UACR)];Pearson's method was used to analyze the correlation between serum LCN-2,TSP-2 levels and renal function indicators in DN patients;Logistic regression model was used to analyze the factors contributing to poor prognosis in DN patients;Receiver operating characteristic(ROC)curve was established to evaluate the predictive value of serum LCN-2 and TSP-2 levels for poor prognosis in DN patients.Results The serum levels of LCN-2,TSP-2,and UACR in the healthy control group,simple T2DM group,and DN group increased sequentially,while eGFR decreased sequentially(F/P=48.365/<0.001,57.480/<0.001,218.946/<0.001,253.488/<0.001);The 3 year incidence of poor prognosis in 155 DN patients was 24.52%(38/155);Compared with the subgroup with good prognosis,the subgroup with poor prognosis had higher LCN-2,TSP-2,UACR,and lower eGFR(t/P=7.057/<0.001,6.457/<0.001,4.967/<0.001,5.398/<0.001);The serum levels of LCN-2 and TSP-2 in DN patients were negatively correlated with eGFR(r/P=-0.745/<0.001,-0.731/<0.001),and positively correlated with UACR(r/P=0.703/<0.001,0.691/<0.001);Multivariate logistic regression showed that stage 4 chronic kidney disease,high glycated
作者
石敏
王琼
周英旎
张颖
李晓苗
Shi Min;Wang Qiong;Zhou Yingni;Zhang Ying;Li Xiaomiao(Department of Endocrinology,The First Affiliated Hospital of the Chinese People's Liberation Army Air Force Medical University,Shaanxi Province,Xi'an 710032,China)
出处
《疑难病杂志》
CAS
2024年第10期1227-1232,共6页
Chinese Journal of Difficult and Complicated Cases
基金
国家自然科学基金资助项目(81573746)。
