多配体蛋白聚糖1和不对称二甲基精氨酸在2型糖尿病肾病早期诊断及病程监测的临床价值  

Clinical value of measuring syndecan-1 and asymmetric dimethylarginine in early diagnosis and disease course monitoring of patients with type 2 diabetic kidney disease

作　　者：刘丽[1] 杨红梅 张巧玲 杨宏秀[1] 刘蕾[1] 李超[1] 袁宝军[1] Liu Li;Yang Hongmei;Zhang Qiaoling;Yang Hongxiu;Liu Lei;Li Chao;Yuan Baojun(Department of Laboratory Medicine Kailuan General Hospital,Tangshan 063100,China)

机构地区：[1]开滦总医院检验科,唐山063100

出　　处：《中华检验医学杂志》2024年第7期789-797,共9页Chinese Journal of Laboratory Medicine

摘　　要：目的:探讨内皮损伤指标多配体蛋白聚糖1(SDC1)、不对称二甲基精氨酸(ADMA)对2型糖尿病肾病(DKD)患者早期诊断及病程监测的临床价值。方法:横断面研究。选取2020年12月至2021年12月开滦总医院内分泌科住院的2型糖尿病患者232例进行回顾性分析,根据尿白蛋白/尿肌酐比值(UACR)和估算的肾小球滤过率(eGFR)分为单纯糖尿病组(50例)和DKD组(182例),其中DKD组根据DKD进展风险进一步分为低进展风险糖尿病肾病(LDKD)亚组90例、中进展风险糖尿病肾病(MDKD)亚组55例、高进展风险糖尿病肾病(HDKD)亚组37例。以同期体检中心40名健康者为健康对照组。根据N-乙酰-β-D-氨基葡萄糖苷酶/尿肌酐(NAG/Ucr)水平四分位数值,将DKD组患者分为Q1~Q4亚组,分别为45、45、46和46例。检测各组一般生化指标、SDC1和ADMA水平。采用Spearman相关法分析DKD患者SDC1、ADMA与肾小球、肾小管损伤指标相关性。多因素有序Logistic回归分析DKD进展风险及肾小管损伤的影响因素,受试者工作特征(ROC)曲线评价SDC1、ADMA对DKD的诊断性能。结果:DKD组收缩压、舒张压、甘油三酯(TG)、血肌酐(Scr)、尿酸(UA)、NAG/Ucr、SDC1、ADMA水平高于SDM组和健康对照组(P均<0.05),总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(AporB)、糖化血红蛋白(HbA 1c)水平高于健康对照组,高密度脂蛋白胆固醇(HDL-C)水平低于健康对照组(P均<0.05)。HDKD亚组SDC1水平高于SDM组和LDKD亚组,ADMA水平高于SDM组,低于LDKD亚组(P均<0.05);MDKD亚组SDC1水平高于SDM组和LDKD亚组,ADMA水平高于SDM组,低于LDKD亚组(P均<0.05);LDKD亚组SDC1、ADMA水平高于SDM组(P均<0.05)。NAG/Ucr水平Q4亚组TC、AporB、HbA 1c、Scr、UACR、SDC1水平高于Q1亚组,Scr、UACR、SDC1水平高于Q2亚组,Q3亚组HbA 1c、Scr、UACR、SDC1水平高于Q1亚组(P均<0.05)。Spearman相关分析显示,SDC1与UACR、NAG/Ucr呈正相关(r=0.757、0.566,P均<0.05),与eGFR呈负相Objective To explore the clinical value of syndecan-1(SDC1),asymmetric dimethylarginine(ADMA)assessment in the early diagnosis and course monitoring of patients with type 2 diabetic kidney disease(DKD).Methods This is a cross-sectional study.A total of 232 patients with type 2 diabetes admitted to the Department of Endocrinology of Kailuan General Hospital from December 2020 to December 2021 were included.The general biochemical indexes,SDC1 and ADMA were detected.According to urinary albumin/creatinine ratio(UACR)and estimated glomerular filtration rate(eGFR),patients were divided into simple diabetes group(50 cases)and DKD group(182 cases).According to the risk of progression of DKD,the DKD group was further divided into low-progression diabetic nephropathy(LDKD)subgroup(90 cases),medium-progression diabetic nephropathy(MDKD)subgroup(55 cases),and high-progression diabetic nephropathy(HDKD)subgroup(37 cases).Forty healthy people undergoing physical examination during the same period in our hospital were selected as the healthy control group.According to the quartile value of N-acetyl-β-D-glucosaminase/urinary creatinine(NAG/Ucr),the DKD group was divided into Q1-Q4 subgroups,with 45,45,46 and 46 cases,respectively.Spearman correlation was used to analyze the correlation between SDC1,ADMA and glomerular and renal tubule injury indexes in DKD patients.Multifactor ordered Logistic regression was used to analyze the influencing factors of the progression risk of DKD and renal tubular injury.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic performance of SDC1 and ADMA for DKD.Results The levels of systolic blood pressure,diastolic blood pressure,triglyceride(TG),serum creatinine(Scr),uric acid(UA),NAG/Ucr,SDC1 and ADMA in DKD group were higher than those in SDM group and healthy control group(all P<0.05).The levels of total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),apolipoprotein B(ApoB),and hemoglobin A1c(HbA1c)in DKD group were higher than those in healthy control

关 键 词：糖尿病 2型 糖尿病肾病 多配体蛋白聚糖1 不对称二甲基精氨酸 

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