脂蛋白相关磷脂酶A2与2型糖尿病患者白蛋白尿的相关性研究  

Correlation between lipoprotein-associated phospholipase A2 and albuminuria in patients with type 2 diabetes mellitus

作　　者：倪会芳 丁源 付群 贺慧甜 吴文迅[1] Ni Huifang;Ding Yuan;Fu Qun;He Huitian;Wu Wenxun(Dept of Endocrinology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院内分泌科,郑州450052

出　　处：《安徽医科大学学报》2023年第2期321-326,共6页Acta Universitatis Medicinalis Anhui

基　　金：河南省高等学校重点科研项目(编号:18A320068)。

摘　　要：目的探讨脂蛋白相关磷脂酶A2(Lp-PLA2)与2型糖尿病(T2DM)患者发生白蛋白尿的相关性。方法选取200例T2DM患者,收集患者的一般资料及相关实验室指标。根据尿白蛋白/肌酐比值(UACR)将其分为正常白蛋白尿组(UACR<30 mg/g,n=66)、微量白蛋白尿组(30 mg/g≤UACR<300 mg/g,n=64)和大量白蛋白尿组(UACR≥300 mg/g,n=70)。并采用Lp-PLA2三分位数将患者分为低Lp-PLA2组(Lp-PLA2<104 ng/ml,n=66)、中Lp-PLA2组(104 ng/ml≤Lp-PLA2<161 ng/ml,n=67)和高Lp-PLA2组(Lp-PLA2≥161 ng/ml,n=67)。采用单因素方差分析和非参数检验比较各组间变量差异;Pearson相关和Spearman相关分析Lp-PLA2与各指标间相关性;多因素Logistic回归分析探讨T2DM患者发生白蛋白尿的影响因素;受试者工作特征(ROC)曲线评价Lp-PLA2对T2DM患者发生白蛋白尿的预测价值。结果大量白蛋白尿组Lp-PLA2水平明显高于正常白蛋白尿组和微量白蛋白尿组,微量白蛋白尿组Lp-PLA2水平高于正常白蛋白尿组,差异均有统计学意义(P<0.05)。随着Lp-PLA2三分位数的递增,患者UACR逐渐增加,差异有统计学意义(P<0.05)。相关性分析显示T2DM患者Lp-PLA2水平与糖尿病病程、收缩压(SBP)、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、血尿素氮(BUN)、血肌酐(Scr)和UACR呈正相关,与肾小球滤过率(eGFR)呈负相关(P<0.05)。多因素Logistic回归分析显示Lp-PLA2[OR=1.046,95%CI(1.031,1.060)]是T2DM患者发生白蛋白尿的独立危险因素(P<0.05)。Lp-PLA2预测T2DM患者发生白蛋白尿的ROC曲线下面积为0.902[95%CI(0.862,0.942)],最佳切点值为148 ng/ml,敏感度为65.7%,特异度为98.5%。结论Lp-PLA2与T2DM患者白蛋白尿的发生密切相关,为临床糖尿病肾病的诊断和治疗提供了新的思路。Objective To explore the correlation between lipoprotein-associated phospholipase A2(Lp-PLA2)level and albuminuria in patients with type 2 diabetes mellitus(T2DM).Methods 200 T2DM patients were chosen to collect general data and relevant laboratory indicators.According to the urinary albumin/creatinine ratio(UACR),they were divided into normal group(UACR<30 mg/g,n=66),microalbuminuria group(30 mg/g≤UACR<300 mg/g,n=64)and macroalbuminuria group(UACR≥300 mg/g,n=70).On the basis of Lp-PLA2 tertile,they were divided into low Lp-PLA2 group(Lp-PLA2<104 ng/ml,n=66),medium Lp-PLA2 group(104 ng/ml≤Lp-PLA2<161 ng/ml,n=67)and high Lp-PLA2 group(Lp-PLA2≥161 ng/ml,n=67).Group differences were compared by analysis of variance and nonparametric test.Associations between Lp-PLA2 and other indicators were performed by Pearson correlation and Spearman correlation.Related factors of albuminuria in T2DM patients were explored by multivariate Logistic regression analysis.In addition,receiver operating characteristic(ROC)curve analysis was applied to evaluate the predictive value of Lp-PLA2 for albuminuria in T2DM patients.Results Lp-PLA2 was significantly higher in the macroalbuminuria group than that in both the normal group and the microalbuminuria group,and the differences were statistically significant(P<0.05).Compared with the normal group,Lp-PLA2 in the microalbuminuria group increased(P<0.05).With the increase in Lp-PLA2 tertile,there was gradual increase in UACR,and the difference was statistically significant(P<0.05).Correlation analysis showed that Lp-PLA2 was positively correlated with duration of DM,systolic blood pressure(SBP),glycosylated hemoglobin(HbA1c),fasting blood glucose(FBG),blood urea nitrogen(BUN),serum creatinine(Scr),UACR and negatively correlated with estimated glomerular filtration rate(eGFR)(P<0.05).Multivariate Logistic regression analysis showed that Lp-PLA2[OR=1.046,95%CI(1.031,1.060)]was an independent risk factor for albuminuria(P<0.05).The AUC of Lp-PLA2 for predicting albuminuria was 0.902[

关 键 词：脂蛋白相关磷脂酶A2 2型糖尿病 白蛋白尿 尿白蛋白/肌酐比值 

分 类 号：R587.1[医药卫生—内分泌]