血清肾损伤分子1、中性粒细胞明胶酶相关脂质运载蛋白与肥胖糖尿病肾脏疾病患者胃旁路术后肾脏功能改善相关性的研究  

Correlation between serum KIM-1,NGAL and diabetic kidney disease remission after gastric bypass surgery in obese patiensts

作　　者：于洪恩 孙娟 李小霜 何苗苗 张珍华 YU Hongen;SUN Juan;LI Xiaoshuang(The First Clinical Medical College of Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州医科大学第一临床医学院,221004 [2]徐州医科大学附属医院内分泌科

出　　处：《中国糖尿病杂志》2023年第12期916-920,共5页Chinese Journal of Diabetes

基　　金：江苏省徐州市科学技术局社会发展项目(KC15SH089)。

摘　　要：目的探讨血清肾损伤分子1(KIM-1)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)与肥胖DKD患者胃旁路术后DKD缓解的相关性。方法选取2021年1月至2022年1月于徐州医科大学附属医院胃肠外科接受胃旁路术的肥胖DKD患者79例,根据术后UACR是否正常分为DKD缓解组(n=47)和DKD未缓解组(n=32)。比较两组手术前后一般资料、生化指标、血清KIM-1及NGAL等。结果79例肥胖DKD患者无术中并发症发生及中转开腹。两组术后BMI、FPG、HbA1c、SBP、DBP、TC、TG、LDL-C、血尿酸、UACR、KIM-1及NGAL较术前降低(P<0.05),HDL-C较术前升高(P<0.05)。缓解组SBP、DBP、血肌酐(Scr)、BUN、UACR、KIM-1、NGAL低于未缓解组(P<0.05)。Spearman相关分析显示,KIM-1、NGAL与Scr、BUN、UACR呈正相关(P<0.05),与eGFR呈负相关(P<0.05)。Logistic回归分析显示,SBP、UACR、KIM-1、NGAL是DKD缓解的影响因素。血清KIM-1、NGAL及联合预测DKD缓解的受试者工作特征曲线下面积为0.801、0.757、0.863。结论血清KIM-1、NGAL可预测肥胖DKD患者胃旁路术后DKD缓解。Objective To investigate the correlation between serum renal injury molecule-1(KIM-1)and neutrophil gelatinase-associated lipocalin(NGAL)in the remission of diabetic kidney disease(DKD)after gastric bypass surgery in obese DKD patients.MethodsSeventy-nine obese patients with DKD who received gastric bypass surgery in our hospital from January 2021 to January 2022 were selected and divided into DKD remission group(n=47)and DKD non-remission group(n=32)according to whether UACR decreased to normal level after surgery.Preoperative and postoperative general data were collected and biochemical indices,serum KIM-1 and NGAL levels were detected.Results None of the 79 obese DKD patients had intraoperative complications or switched to laparotomy.BMI,FPG,HbAic,SBP,DBP,TC,TG,LDL-C,SUA,UACR,KIM-1 and NGAL were decreased after surgery,while HDL-C was increased after surgery(P<O.05).SBP,DBP,Scr,BUN,UACR,KIM-1 and NGAL in remission group were lower than those in non-remission group(P<0.05).Spearman correlation analysis showed that the levels of KIM-1 and NGAL were positively correlated with Scr,BUN and UACR(P<0.05),but negatively correlated with eGFR(P<0.05).Logistic regression analysis showed that SBP,UACR,KIM-1 and NGAL were influencing factors for DKD remission after gastric bypass surgery.The areas under ROC curve of serum KIM-1,NGAL and combined prediction of DKD remission were 0.801,0.757 and 0.863,respectively.Conclusion Serum KIM-1 and NGAL can predict DKD remission in obese DKD patients aftergastric bypass surgery.

关 键 词：肥胖 胃旁路术 糖尿病肾脏疾病 肾损伤分子1 中性粒细胞明胶酶相关脂质运载蛋白 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]