血清维生素E结合蛋白及adropin蛋白在DN中的临床价值  

Clinical roles of serum AFM and adropin in patients with DN

作　　者：田茜 李宝新[2] 李娜 郭淑芹[2] 张玛丽 李杰[2] 王翯[2] 张云良[2] TIAN Xi;LI Baoxin;LI Na;GUOShuqin;ZHANG Mali;LI Jie;WANG He;ZHANG Yunliang(Graduate School,Chengde Medical University,Chengde 067000,Hebei,China;Department of Endocrinology,Baoding First Central Hospital,Hebei Provincial Center for Optical Sensing Innovations,Baoding 071000,Hebei,China)

机构地区：[1]承德医学院研究生学院,河北承德067000 [2]保定市第一中心医院内分泌科河北省光学感知技术创新中心,河北保定071000

出　　处：《检验医学》2020年第11期1120-1125,共6页Laboratory Medicine

基　　金：国家自然科学基金资助项目(81500644);保定市科学技术研究与发展指导计划(17ZF187)。

摘　　要：目的探讨血清维生素E结合蛋白(AFM)及adropin蛋白(AD)在糖尿病肾病(DN)中的价值。方法选取2型糖尿病(T2DM)患者180例,根据尿白蛋白/肌酐比值(UACR)将T2DM患者分为3个亚组:正常UACR组(UACR<30 mg/g)、低UACR组(UACR为30~<300 mg/g)、高UACR组(UACR≥300 mg/g)。以52名体检健康者作为正常对照组。收集所有对象的一般资料,同时检测相关血液指标[AFM、AD、空腹血糖(FBG)、三酰甘油(TG)、总胆固醇(TC)、血清肌酐(SCr)、天门冬氨酸氨基转移酶(AST)、尿素氮(BUN)、总蛋白(TP)、白蛋白(Alb)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)]及尿液指标[尿微量白蛋白(mAlb)、24 h尿蛋白],计算胰岛素抵抗指数(HOMA-IR)、估算肾小球滤过率(eGFR)、尿白蛋白排泄率(UAE)及UACR。采用Spearman相关分析及多元线性回归分析评估AFM及AD与各项指标之间的关系。采用受试者工作特征(ROC)曲线评估AFM及AD对DN的诊断价值。结果正常对照组、正常UACR组、低UACR组、高UACR组AFM水平依次升高、AD水平依次降低,各组间差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,AFM与收缩压、BUN、SCr、FBG、HbA1c、FINS、HOMA-IR、mAlb、UAE、UACR及24 h尿蛋白均呈正相关(P<0.05),与TP、Alb、AD均呈负相关(P<0.05)。AD与TP及Alb均呈正相关(P<0.05),与收缩压、BUN、SCr、FBG、HbA1c、FINS、HOMAIR、mAlb、UAE、UACR、24 h尿蛋白及AFM均呈负相关(P<0.05)。多元线性回归分析结果显示,血清AFM水平的影响因素为AD、HbA1c、UACR及24 h尿蛋白(β值分别为-0.90、0.11、0.16、0.11,P<0.05),血清AD水平的影响因素为AFM、UACR及HbA1c(β值分别为-0.53、-0.45、-0.11,P<0.05)。ROC曲线分析结果显示,AFM和AD诊断DN的曲线下面积(AUC)分别为0.80、0.96,最佳临界值为87.57 mg/L、171.86 pg/mL,敏感性分别为78.30%、97.50%,特异性分别为71.50%、92.00%。结论血清AFM和AD对DN有一定的临床价值,或可用于DN的辅助诊断。Objective To investigate the roles of serum afamin(AFM)and adropin(AD)in patients with diabetic nephropathy(DN).Methods According to the urinary albumin to creatinine ratio(UACR),180 patients with type 2 diabetes mellitus(T2DM)were classified into 3 groups,normal UACR group(UACR<30 mg/g),low UACR group(UACR 30-<300 mg/g)and high UACR group(UACR≥300 mg/g).Totally,52 healthy subjects were enrolled as healthy control group.General information was collected.The levels of AFM,AD,fasting blood glucose(FBG),triglyceride(TG),total cholesterol(TC),serum creatinine(SCr),aspartate aminotransferase(AST),blood urea nitrogen(BUN),total protein(TP),albumin(Alb),glycated hemoglobin A1c(HbA1c),fasting insulin(FINS)and urinary microalbumin(mAlb),24 h urine protein were determined.The homeostasis model assessment for insulin resistance(HOMA-IR),estimated glomerular filtration rate(eGFR),urinary albumin excretion(UAE)and UACR were calculated.Spearman correlation analysis and multiple linear regression analysis were used to assess the correlation between AFM and AD levels with various influencing factors.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic roles of AFM and AD for the diagnosis of DN.Results The AFM levels increased and the AD levels decreased in healthy control group,normal UACR group,low UACR group and high UACR group(P<0.05).Spearman correlation analysis showed that AFM levels were positively correlated with systolic blood pressure,BUN,SCr,FBG,HbA1c,FINS,HOMA-IR,mAlb,UAE,UACR and 24 h urine protein(P<0.05),and were negatively correlated with TP,Alb and AD(P<0.05).The AD levels were positively correlated with TP and Alb(P<0.05),and were negatively correlated with systolic blood pressure,BUN,SCr,FBG,HbA1c,FINS,HOMA-IR,mAlb,UAE,UACR,24 h urine protein and AFM(P<0.05).Multiple linear regression analysis showed that the influencing factors of serum AFM levels were AD,HbA1c,UACR and 24 h urine protein(β=-0.90,0.11,0.16 and 0.11,P<0.05).The AFM,UACR and HbA1c were influencing factors of serum

关 键 词：维生素E结合蛋白 adropin蛋白 糖尿病肾病 

分 类 号：R446.1[医药卫生—诊断学]