血清FGF19联合25(OH)D预测1型糖尿病患儿并发微血管并发症的价值  

Value of serum FGF19 combined with 25(OH)D in predicting MC in children with type 1 diabetes mellitus

作　　者：苏艳花 郝慧玲 王丽花[1] SU Yanhua;HAO Huiling;WANG Lihua(Department of Endocrine,Children's Hospital of Shanxi,Taiyuan 030013,China)

机构地区：[1]山西省儿童医院内分泌科,太原030013

出　　处：《山东医药》2023年第28期18-22,共5页Shandong Medical Journal

基　　金：山西省卫生健康科研课题(2019049)。

摘　　要：目的探讨血清成纤维细胞生长因子19(FGF19)联合25羟基维生素D[25(OH)D]预测1型糖尿病(T1DM)患儿并发微血管并发症(MC)的价值。方法选取T1DM患儿109例(T1DM组),另取同期儿科接诊的体检健康儿童50例为对照组,采用酶联免疫吸附法检测血清FGF19、25(OH)D,全自动生化分析仪检测空腹血糖(FPG)和空腹胰岛素(FINS);全自动糖化血红蛋白分析仪检测糖化血红蛋白(HbA1c),采用稳态模型评估IR指数(HOMAIR)。Pearson/Spearman相关性分析T1DM患儿血清FGF19、25(OH)D水平与糖代谢指标的相关性。随访1年,记录T1DM患儿并发MC的情况,采用多因素Logistic回归模型分析T1DM患儿并发MC的影响因素,采用受试者工作特征(ROC)曲线分析血清FGF19、25(OH)D水平对T1DM患儿并发MC的预测价值。结果T1DM组血清FGF19、25(OH)D水平低于对照组(P均<0.05),FPG、FINS、HbA1c、HOMA-IR高于对照组(P均<0.05)。Pearson/Spearman相关性分析显示,T1DM患儿血清FGF19水平与FPG、FINS、HbA1c、HOMA-IR呈负相关(rs分别为-0.612、-0.605、-0.647、-0.790,P均<0.05)。血清25(OH)D水平与FPG、FINS、HbA1c、HOMA-IR呈负相关(r分别为-0.701、-0.694、-0.652、-0.797,P均<0.05)。随访1年,109例T1DM患儿MC发生率为25.69%(28/109)。多因素Logistic回归分析显示,HbA1c、HOMA-IR为T1DM患儿并发MC的独立危险因素,FGF19、25(OH)D为独立保护因素(P均<0.05)。ROC曲线分析显示,血清FGF19和25(OH)D单独与联合预测T1DM患儿并发MC的曲线下面积(AUC)分别为0.773、0.771、0.874,FGF19联合25(OH)D预测的AUC高于单独预测(P均<0.05)。结论血清FGF19、25(OH)D水平降低与T1DM患儿糖代谢紊乱和MC发生有关,二者可能成为T1DM患儿并发MC的辅助预测指标,FGF19联合25(OH)D预测T1DM患儿并发MC的价值较高。Objective To explore the value of serum fibroblast growth factor 19(FGF19)combined with 25 hydroxyvitamin D[25(OH)D]in predicting microvascular complications(MC)in children with type 1 diabetes mellitus(T1DM).Methods Totally 109 children with T1DM(T1DM group)were selected,and 50 healthy children with physical examination in pediatric department during the same period were selected as the control group.Serum FGF19 and 25(OH)D levels were detected using enzyme-linked immunosorbent assay,and fasting blood glucose(FPG)and fasting insulin(FINS)were measured by the fully automatic biochemical analyzer.The fully automatic glycated hemoglobin analyzer was used to detect the glycated hemoglobin A1c(HbA1c),and a steady-state model was used to evaluate the IR index(HOMA-IR).Pearson/Spearman correlation was used to analyze the correlation between serum FGF19 and 25(OH)D levels and glucose metabolism indexes in children with T1DM.They were followed up for 1 year,and we recorded the incidence of MC in children with T1D.Multifactorial Logistic regression model was used to analyze the influencing factors for MC in children with T1DM,and the predictive value of serum FGF19 and 25(OH)D levels in T1DM children with MC was analyzed by using receiver operating characteristic(ROC)curve.Results The serum levels of FGF19 and 25(OH)D in the T1DM group were lower than those in the control group(both P<0.05),while FPG,FINS,HbA1c,and HOMA-IR were higher than those in the control group(all P<0.05).Pearson/Spearman correlation analysis showed that serum FGF19 level in T1DM patients was negatively correlated with FPG,FINS,HbA1c,and HOMA-IR(rs=0.612,-0.605,-0.647,-0.790,respectively;all P<0.05).The serum 25(OH)D level was negatively correlated with FPG,FINS,HbA1c,and HOMA-IR(r=-0.701,-0.694,-0.652,-0.797,respectively;all P<0.05).At 1-year follow-up,the incidence of MC in 109 children with T1DM was 25.69%(28/109).Multi-factor Logistic regression analysis showed that HbA1c and HOMA-IR were independent risk factors for MC in children with T1DM,and

关 键 词：1型糖尿病 成纤维细胞生长因子19 25羟基维生素D 糖代谢 微血管并发症 儿童 

分 类 号：R587.1[医药卫生—内分泌]