1型糖尿病患者肾脏生物学标志物与D-二聚体相关性研究  

Correlation between renal function biomarkers and D-dimer levels in type 1 diabetes mellitus

作　　者：潘绍标[1] 周彩莲[1] 陈丽春[1] 陈亮[1] Zhou Cailian;Chen Lichun;Chen Liang(Department of Endocrinology,Taizhou Hospital of Zhejiang Province,Taizhou 317000,China)

机构地区：[1]浙江省台州医院内分泌科,317000

出　　处：《中国医药》2020年第6期877-881,共5页China Medicine

基　　金：浙江省医药卫生科技计划(2018KYA191)。

摘　　要：目的评估1型糖尿病(T1DM)患者肾脏生物学标志物与D-二聚体的关系。方法回顾性纳入2009年1月至2019年1月于浙江省台州医院就诊的18~60岁的T1DM患者179例。收集患者临床资料、肾脏生物学标志物如血肌酐、血尿素氮、胱抑素C、估算肾小球滤过率(eGFR)和尿白蛋白与肌酐比值(ACR)以及D-二聚体水平,根据D-二聚体水平将患者分成低D-二聚体组(<318μg/L,121例)和高D-二聚体组(≥318μg/L,58例),比较2组临床资料,分析各指标与D-二聚体关系。结果高D-二聚体组患者eGFR水平低于低D-二聚体组[(93±20)ml/(min·1.73 m^2)比(115±29)ml/(min·1.73 m^2)],血肌酐、血尿素氮、胱抑素C水平和ACR高于低D-二聚体组[(12±4)mg/L比(10±4)mg/L、(271±102)mg/L比(215±45)mg/L、(1.13±0.28)mg/L比(0.81±0.17)mg/L、(46±7)mg/g比(13±4)mg/g],差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,调整性别和年龄后,T1DM患者高D-二聚体水平与胱抑素C(≥0.92 mg/L)的相关性(比值比=9.104,P<0.001)仍高于与ACR(≥30 mg/g)、血肌酐(≥13 mg/L)、eGFR[<60 ml/(min·1.73 m^2)]和血尿素氮(≥248.9 mg/L)的相关性(比值比=5.131、6.769、8.436、3.389,均P<0.05)。Spearman相关分析结果进一步表明,与其他肾脏生物学标志物相比,D-二聚体水平与胱抑素C的相关性最高(r=0.512,P<0.001)。结论胱抑素C、血肌酐、血尿素氮、eGFR、ACR等肾脏生物学标志物都显示出与D-二聚体的相关性,其中胱抑素C的相关性最高。胱抑素C可能在同时评估T1DM患者肾功能下降和高凝状态方面具有重要作用。Objective To evaluate the relation between renal function biomarkers and D-dimer in patients with type 1 diabetes mellitus(T1DM).Methods A retrospective study enrolled 179 T1DM patients aging 18 to 60 years old who were treated in Taizhou Hospital of Zhejiang Province from January 2009 to January 2019.Clinical data,renal biomarkers such as creatinine,blood urea nitrogen,cystatin C,estimated glomerular filtration rate(eGFR),albumin to creatinine ratio(ACR)and D-dimer levels were collected.Patients were divided into low D-dimer group(<318μg/L,121 cases)and high D-dimer group(≥318μg/L,58 cases)according to D-dimer levels.The clinical data were analyzed.Results The level of eGFR in high D-dimer group was lower than that in low D-dimer group[(93±20)ml/(min·1.73 m^2)vs(115±29)ml/(min·1.73 m^2)];the levels of creatinine,urea,cystatin C and ACR were higher than those in low D-dimer group[(12±4)mg/L vs(10±4)mg/L,(271±102)mg/L vs(215±45)mg/L,(1.13±0.28)mg/L vs(0.81±0.17)mg/L,(46±7)mg/g vs(13±4)mg/g,all P<0.05].Multivariate logistic regression analysis showed that the correlation between high D-dimer level and cystatin C(≥0.92 mg/L)in T1DM patients was higher than ACR(≥30 mg/g),creatinine(≥13 mg/L),eGFR[<60 ml/(min·1.73 m^2)]and urea(≥248.9 mg/L)after adjusting gender and age(odds ratio=9.104,P<0.001).Spearman correlation analysis showed that D-dimer level was more correlated with cystatin C than other renal biomarkers(r=0.512,P<0.001).Conclusions Cystatin C,creatinine,blood urea nitrogen,eGFR and ACR showed correlation with D-dimer.Cystatin C may play an important role in assessment of renal dysfunction and hypercoagulability in patients with T1DM.

关 键 词：1型糖尿病 D-二聚体 胱抑素C 肌酐 尿白蛋白 

分 类 号：R587.2[医药卫生—内分泌]