尿诱骗受体2/肌酐水平与糖尿病肾小管病预后的关系  

Relationship between urinary DcR2/Cr level and prognosis in patients with diabetic tubulopathy

作　　者：王卫东 陈佳 何娅妮 陈客 Weidong Wang;Jia Chen;Yani He;Kehong Che(Department of Nephrology,Daping Hospital,Army Specialized Medical Center,State Key Laboratory of Trauma,Burns and Complex Injuries,Chongqing 400042,China;Department of Nephrology,Daping Hospital,Army Specialized Medical Center,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学陆军特色医学中心、大坪医院肾内科,重庆400042 [2]重庆,陆军军医大学创伤、烧伤与复合伤国家重点实验室,重庆400042

出　　处：《中华肾病研究电子杂志》2023年第2期61-66,共6页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

基　　金：国家自然科学基金项目(82270768);重庆市科技创新引导课题(2022YSZX-JCX0007CSTB)。

摘　　要：目的探讨尿诱骗受体2/肌酐(DcR2/Cr)水平是否可作为预测糖尿病肾小管病(DT)预后的生物标志物。方法纳入2018至2021年经我科病理诊断为DT并留取尿液标本的患者共计65例,对基本资料、实验室检查结果、病理检查等进行回顾性分析,并随访患者、记录终点事件。根据尿DcR2/Cr水平分3组:第1组:DcR2/Cr<321 ng/mmol,第2组:321≤DcR2/Cr≤505 ng/mmol,第3组:DcR2/Cr>505 ng/mmol。使用单因素方差分析、Kruskal-Wallis检验进行组间比较,卡方检验进行率的比较,Cox回归模型分析尿DcR2/Cr与DT预后的关系,数据采用SPSS 26.0统计学软件进行处理。结果随着DcR2/Cr水平增高,尿白蛋白肌酐比(ACR)、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、胱抑素C(CYC)、血肌酐水平呈增高趋势,而尿肌酐、估算肾小球滤过率(eGFR)逐渐下降(P<0.05)。血红蛋白、血清白蛋白水平随着DcR2/Cr增高而下降(P<0.05),甘油三酯、低密度脂蛋白随DcR2/Cr增高而增高(P<0.05)。DcR2/Cr水平与ACR、CYC、NAG均呈正相关(均P<0.01),但与eGFR呈负相关(P<0.01)。尿DcR2/Cr水平与间质纤维化肾小管萎缩(IFTA)评分、肾动脉玻璃样变评分、肾动脉硬化评分均呈正相关(均P<0.05)。Cox回归模型分析显示,尿DcR2/Cr水平与患者预后呈显著相关(P=0.001),其中第3组患者不良预后的发生风险是第1组患者的11.416倍。Kaplan-Meier生存曲线显示患者的DcR2/Cr水平越高,预后越差。受试者工作特征(ROC)曲线分析显示,尿DcR2/Cr的曲线下面积(AUC)最大,高于ACR、CYC和血肌酐。结论尿DcR2/Cr水平与DT密切相关,可能是预测DT预后的一个生物标志物。Objective To investigate whether urinary decoy receptor 2/urine creatinine(DcR2/Cr)could be used as a biomarker to predict the prognosis of diabetic tubulopathy(DT).Methods A total of 65 patients who were pathologically diagnosed with DT and had urine specimens retained in our department from 2018 to 2021 were included.Basic data,laboratory findings,and pathological information were collected for retrospective analysis.The patients were followed up,and endpoint events were recorded.Aaccording to urinary DcR2/Cr levels,the patients were divided into three groups,group 1(DcR2/Cr<321 ng/mmol),group 2(321≤DcR2/Cr≤505 ng/mmol),and group 3(DcR2/Cr>505 ng/mmol).Univariate analysis of variance and Kruskal Wallis test were used for groups comparison,and chi square test was used for comparison of rates.Cox regression was applied to analyze the relationship between urinary DcR2/Cr level and prognosis of DT.The data was processed with the SPSS 26.0 statistical software.Results With the increase of DcR2/Cr level,urinary albumin-to-creatinine ratio(ACR),N-acetyl-β-D-glucosaminidase(NAG),cystatin C(CYC),and serum creatinine tended to increase,while urinary creatinine and estimated glomerular filtration rate(eGFR)gradually decreased(P<0.05).Hemoglobin and serum albumin levels decreased with the increase of urinary DcR2/Cr level(P<0.05),while triglyceride and low density lipoprotein(LDL)increased with the increase of DcR2/Cr(P<0.05).The DcR2/Cr level was positively correlated with ACR(P<0.01),CYC(P<0.01),and NAG(P<0.01),but negatively correlated with eGFR(P<0.01).The urinary DcR2/Cr level was positively correlated with the interstitial fibrosis and tubular atrophy(IFTA)score,renal artery hyalinosis score,and renal atherosclerosis score(all P<0.05).Cox regression analysis revealed a significant correlation between the urinary DcR2/Cr level and the occurrence of adverse prognosis(P=0.001).The risk of adverse prognosis of the group 3 was 11.416 times that of group 1.The Kaplan-Meier survival curve showed that the higher the uri

关 键 词：尿 DcR2/Cr 糖尿病肾小管病 肾小管间质损伤 

分 类 号：R692.6[医药卫生—泌尿科学]