可溶性髓样细胞触发受体-1和组织金属蛋白酶抑制剂3水平与糖尿病肾病严重程度及预后的关系  

Relationships of soluble triggering receptor expressed on myeloid cell-1 and tissue inhibitor of metalloproteinase 3 levels with the severity and prognosis of diabetic nephropathy

作　　者：赵珊[1] 尹晶晶[1] 李微 陈谱[3] ZHAO Shan;YIN Jingjing;LI Wei;CHEN Pu(Department of Laboratory Medicine,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shaanri 710o61,China;Department of Blood Transfusion and Laboratory,the First Hospital of Yulin,Yulin,Shaanxi 719000,China;Department of Endocrinology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shaanxi 710061,China)

机构地区：[1]西安交通大学第一附属医院检验科,陕西西安710061 [2]榆林市第一医院输血检验科,陕西榆林719000 [3]西安交通大学第一附属医院内分泌科,陕西西安710061

出　　处：《中华实用诊断与治疗杂志》2024年第9期947-953,共7页Journal of Chinese Practical Diagnosis and Therapy

基　　金：陕西省自然科学基础研究计划项目(2022JM-609)。

摘　　要：目的观察糖尿病肾病(DN)患者血清可溶性髓样细胞触发受体-1(sTREM-1)、组织金属蛋白酶抑制剂3(TIMP3)水平变化,探讨其与DN患者病情严重程度及预后的关系。方法2018年1月—2020年12月西安交通大学第一附属医院诊治DN患者130例(DN组)、单纯2型糖尿病(T2DM)患者80例(T2DM组),同期健康体检者80例(对照组),均采用ELISA法检测血清sTREM-1、TIMP3水平。DN组患者根据估算肾小球滤过率(eGFR)分为G_(1)期组[eGFR≥90 mL/(min·1.73 m^(2))]31例,G_(2)期组[eGFR 60~<90 mL/(min·1.73 m^(2))]18例,G_(3)期组[eGFR 30~<60 mL/(min·1.73 m^(2))]25例,G_(4)期组[eGFR 15~<30 mL/(min·1.73 m^(2))]56例,比较4组血清sTREM-1、TIMP3水平。随访3年,DN患者根据预后分为预后不良组39例和预后良好组91例,比较2组年龄及血清sTREM-1、TIMP3水平等临床资料。采用Spearman相关法分析DN患者eGFR与血清sTREM-1、TIMP3水平的相关性;采用多因素Cox回归分析DN患者预后不良的影响因素;绘制ROC曲线,评估血清sTREM-1、TIMP3预测DN患者预后不良的效能。结果对照组、T2DM组、DN组血清sTREM-1[(71.45±19.34)、(101.24±24.83)、(138.21±33.68)ng/L]、TIMP3[(968.99±187.77)、(862.21±202.93)、(671.55±160.55)ng/L]水平比较差异均有统计学意义(F=146.005,P<0.001;F=72.384,P<0.001),其中血清sTREM-1水平依次升高(P<0.05),TIMP3水平依次降低(P<0.05)。G_(1)期组、G_(2)期组、G_(3)期组、G_(4)期组血清sTREM-1[(94.41±16.93)、(125.59±14.71)、(138.62±11.68)、(166.33±20.95)ng/L]、TIMP3[(858.87±81.85)、(765.05±64.48)、(696.16±30.38)、(526.82±103.85)ng/L]水平比较差异均有统计学意义(F=112.836,P<0.001;F=114.064,P<0.001),其中血清sTREM-1水平依次升高(P<0.05),TIMP3水平依次降低(P<0.05)。DN患者eGFR与血清sTREM-1水平呈正相关(r=0.787,P<0.001),与血清TIMP3水平呈负相关(r=-0.796,P<0.001)。随访(2.53±0.36)年,130例DN患者预后不良发生率为30.00%。预后不良组年龄[(62.62±11.11)岁]大于预Objective To observe the changes of serum soluble triggering receptor expressed on myeloid cell-1(sTREM-1)and tissue inhibitor of metalloproteinase 3(TIMP3)levels in patients with diabetic nephropathy(DN),and to investigate their relationships with the disease severity and prognosis of DN patients.Methods From January 2018 to December 2020,130 DN patients(DN group),80 type 2 diabetes mellitus(T2DM)patients(T2DM group),and 80 healthy controls(control group)in the First Affiliated Hospital of Xi'an Jiaotong University were detected the serum sTREM-1 and TIMP3 levels using ELISA.Based on estimated glomerular filtration rate(eGFR),DN patients were categorized into G_(1)[eGFR:≥90 mL/(min·1.73 m^(2)),n=31],G_(2)[eGFR:60 to<90 mL/(min·1.73 m^(2)),n=18],G_(3)[eGFR:30 to<60 mL/(min·1.73 m^(2)),n=25],and G_(4)[eGFR:15 to<30 mL/(min·1.73 m^(2)),n=56]stages.The serum sTREM-1 and TIMP3 levels were compared among DN,T2DM and control groups,and across G_(1) to G_(4) stages.DN patients were divided into poor prognosis group(n=39)and good prognosis group(n=91)based on the three-year follow-up results,and the clinical data as age and serum sTREM-1 and TIMP3 levels were compared between two groups.The correlations of eGFR with serum sTREM-1 and TIMP3 levels were analyzed using Spearman's method.Multivariate Cox regression was used to analyze the influencing factors of poor prognosis of DN patients.ROC curves were plotted to evaluate the efficiencies of serum sTREM-1 and TIMP3 levels on predicting poor prognosis of DN patients.Results Significant differences were found in serum sTREM-1[(71.45±19.34),(101.24±24.83),(138.21±33.68)ng/L]and TIMP3 levels[(968.99±187.77),(862.21±202.93),(671.55±160.55)ng/L]among control,T2DM and DN groups(F=146.005,P<0.001;F=72.384,P<0.001),with serum sTREM-1 levels increasing(P<0.05),and TIMP3 levels decreasing sequentially(P<0.05).Significant differences were also observed in serum sTREM-1[(94.41±16.93),(125.59±14.71),(138.62±11.68),(166.33±20.95)ng/L]and TIMP3 levels[(858.87±81.85),(76

关 键 词：糖尿病肾病 可溶性髓样细胞触发受体-1 组织金属蛋白酶抑制剂3 病情严重程度 

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