血清炎性细胞因子水平与糖尿病肾病病情进展的关系  

Association between the levels of serum inflammatory cytokines high-mobility group box-1, insulin-like growth factor-1, vascular endothelial growth factor 165 and progression of diabetic nephropathy

作　　者：陈娟[1] 高鹏霞[1] 石敏[1] 张红[1] Chen Juan;Gao Pengxia;Shi Min;Zhang Hong(Department of Endocrinology,Huai'an First People's Hospital,Nanjing Medical University,Huai'an City of Jiangsu Province 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院内分泌科,江苏省淮安市223300

出　　处：《中华肾脏病杂志》2019年第2期106-112,共7页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81700723).

摘　　要：目的探讨血清高迁移率族蛋白B1(HMGB1)、胰岛素样生长因子1(IGF-1)和血管内皮生长因子165(VEGF165)水平与糖尿病肾病(DN)病情进展的相关性。方法选择2016年1月至2018年1月在南京医科大学附属淮安第一医院被确诊为DN的136例患者(DN组)为研究对象,其中微量蛋白尿组62例、大量蛋白尿组50例、肾功能损害组24例。选择同期健康体检者115例作为健康对照组。检测所有受试者空腹血糖、血总胆固醇、血三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和尿白蛋白/肌酐比值。采用酶联免疫吸附法(ELASA)检测血清HMGB1、IGF-1及VEGF165浓度。应用Pearson相关分析分析血清HMGB1、IGF-1与VEGF165间的相关性;Logistic有序多分类回归分析DN病情进展的危险因素;并绘制受试者工作特征曲线(ROC),评估HMGB1、IGF-1与VEGF165在DN病情进展中的预测价值。结果DN组患者血清HMGB1、IGF-1和VEGF165水平明显高于健康对照组(均P<0.01)。Pearson相关分析结果显示,DN组患者血清HMGB1、IGF-1及VEGF165水平与尿白蛋白/肌酐比值呈正相关(均P<0.01);血清HMGB1与IGF-1、HMGB1与VEGF165、IGF-1与VEGF165间均呈正相关(P<0.01)。Logistic回归分析结果显示,HMGB1、IGF-1和VEGF165水平升高是DN病情进展的独立危险因素(OR值分别为5.50、1.05、1.24,均P<0.05)。HMGB1、IGF-1和VEGF165检测联合诊断DN病情进展的敏感性、特异性和ROC曲线下面积均高于单独检测的诊断效果(曲线下面积分别为0.989、0.984、0.942、0.878,P<0.05)。结论血清HMGB1、IGF-1和VEGF165水平与DN病情严重程度相关,HMGB1、IGF-1和VEGF165联合诊断对DN病情进展的临床预测价值优于HMGB1、IGF-1和VEGF165单一指标。Objectives To determine the association between serum levels of high-mobility group box-1 (HMGB1), insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor 165 (VEGF165) and occurrence and development of diabetic nephropathy (DN). Methods A total of 136 patients diagnosed as diabetic nephropathy (DN group) in Huai'an First People's Hospital between January 2016 to January 2018 were randomly selected in the study, including microalbuminuria group (n=62), macroalbuminuria group (n=50) and renal insufficiency group (n=24). Meanwhile, 115 healthy examiners during the same period were collected as normal control group. Serum glucose, serum total cholesterol (TC), serum triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and urinary albumin/urine creatinine ratio (UAlb/Cr) were detected in all subjects. Enzyme-linked immunosorbent assay (ELISA) was adopted to detect the serum concentrations of HMGB1, IGF-1 and VEGF165. Pearson correlation test was used to analyze the correlation between serum HMGB1, IGF-1 and VEGF165. Logistic ordered multi-classification regression was used to analyze the risk factors of DN progression, and the receiver operating characteristic curve (ROC) was drawn to evaluate the clinical predictive value of HMGB1, IGF-1 and VEGF165 in the progression of DN. Results The concentrations of serum HMGB1, IGF-1 and VEGF165 in DN patients were significantly higher than those in the control group (all P<0.05). There was a positive association between HMGB1 and IGF-1, HMGB1 and VEGF165, IGF-1 and VEGF165 (all P<0.01). Logistic regression analysis showed that elevated levels of HMGB1, IGF-1 and VEGF165 were independent risk factors for DN progression (OR=5.50, 1.05, 1.24, all P<0.05). The sensitivity, specificity and area under ROC curve of combined detection of HMGB1, IGF-1 and VEGF165 were higher than HMGB1, IGF-1 and VEGF165 alone (AUC=0.989, 0.984, 0.942, 0.878, P<0.05). Conclusions The serum levels of HMGB1, IGF-1 and VEGF165 are r

关 键 词：糖尿病肾病 细胞因子类 HMGB1蛋白质 胰岛素样生长因子1 血管内 皮生长因子 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]