糖尿病肾病患者血清GDF-11、S100A4水平与病情、疾病转归的关系分析  

Correlation analysis between serum GDF-11 and S100A4 levels and disease severity and disease outcome in diabetic nephropathy patients

作　　者：高剑[1] 梁铮 赵飞 刘小静 马宁 GAO Jian;LIANG Zheng;ZHAO Fei;LIU Xiaojing;MA Ning(Department of Nephrology,Cangzhou Central Hospital,Cangzhou,Hebei 061000,China)

机构地区：[1]沧州市中心医院肾内一科,河北沧州061000

出　　处：《国际检验医学杂志》2024年第19期2349-2353,2359,共6页International Journal of Laboratory Medicine

基　　金：沧州市重点研发计划指导项目(213106061)。

摘　　要：目的探讨血清生长分化因子-11(GDF-11)、S100钙结合蛋白A4(S100A4)水平与糖尿病肾病(DN)患者病情严重程度、疾病转归的关系。方法选取2021年5月至2023年1月该院收治的95例DN患者作为研究组,另选取110例体检健康者作为健康组。将DN患者根据病情严重程度分为轻度组(n=66)、重度组(n=29),患者出院后连续随访半年,根据预后情况分为预后良好组(n=64)和预后不良组(n=31)。采用酶联免疫吸附试验检测血清GDF-11、S100A4水平,采用Spearman等级相关分析探讨血清GDF-11、S100A4水平与病情严重程度的关系,采用受试者工作特征(ROC)曲线评估血清GDF-11、S100A4对DN患者疾病转归的预测价值,采用多因素Logistic回归分析DN患者疾病转归的影响因素。结果轻度组、重度组血清GDF-11、S100A4水平高于健康组,且重度组高于轻度组(P<0.05)。DN患者血清GDF-11、S100A4水平与病情严重程度均呈正相关(P<0.05)。预后良好组血清GDF-11、S100A4水平低于预后不良组(P<0.05)。血清GDF-11、S100A4预测DN患者疾病转归的曲线下面积(AUC)分别为0.785、0.839,二者联合预测的AUC为0.902。预后不良组2型糖尿病(T2DM)病程、肾小球分级为Ⅲ~Ⅳ级、间质炎症评分为2分、间质性纤维化和小管萎缩(IFTA)评分为2~3分、估算肾小球滤过率<60 mL/(min·1.73 m^(2))占比及总胆固醇、甘油三酯、低密度脂蛋白胆固醇、24 h尿蛋白定量、糖化血红蛋白、C肽、血细胞比容、红细胞沉降率水平高于预后良好组(P<0.05)。多因素Logistic回归分析显示,T2DM病程≥12.0年、IFTA评分≥2分、GDF-11≥700.82 ng/mL、S100A4≥211.53 ng/L是DN患者预后不良的危险因素(P<0.05)。结论血清S100A4、GDF-11水平在DN患者中呈高表达,且与病情严重程度及疾病转归相关,有望作为评估DN病情及预后的潜在标志物。Objective To investigate the relationship between serum levels of growth differentiation factor-11(GDF-11)and S100 calcium binding protein A4(S100A4)and the severity and disease outcome in diabetic nephropathy(DN)patients.Methods A total of 95 DN patients admitted to the hospital from May 2021 to January 2023 were selected as the study group,and 110 healthy people were selected as the healthy group.The DN patients were divided into mild group(n=66)and severe group(n=29)according to the severity of the disease.The patients were followed up for half a year after discharge,and were divided into good prognosis group(n=64)and poor prognosis group(n=31)according to the prognosis.Serum GDF-11 and S100A4 levels were detected by enzyme-linked immunosorbent assay.Spearman rank correlation analysis was used to explore the relationship between serum GDF-11,S100A4 levels and the severity of the disease.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum GDF-11 and S100A4 for disease outcome in DN patients,and multivariate Logistic regression was used to analyze the influencing factors of disease outcome in DN patients.Results The levels of serum GDF-11 and S100A4 in mild group and severe group were higher than those in healthy group,and those in severe group were higher than those in mild group(P<0.05).Serum GDF-11 and S100A4 levels were positively correlated with the severity of DN patients(P<0.05).The good prognosis group had significantly lower serum levels of GDF-11 and S100A4 than the poor prognosis group(P<0.05).The area under the curve(AUC)of serum GDF-11 and S100A4 in predicting the outcome of DN patients was 0.785 and 0.839,respectively,and the AUC of combined prediction was 0.902.The proportion of type 2 diabetes(T2DM)duration,glomerular gradeⅢ-Ⅳ,interstitial inflammation score 2,interstitial fibrosis and tubular atrophy(IFTA)score 2-3 points,estimate glomerular filtration rate<60 mL/(min·1.73 m^(2))and the levels of total cholesterol,triglyceride,low-density lipoprote

关 键 词：糖尿病肾病 生长分化因子-11 S100钙结合蛋白A4 严重程度 预后 

分 类 号：R587.1[医药卫生—内分泌]