血清血管生成素样蛋白4、成纤维细胞生长因子-23水平与糖尿病肾病患者病情严重程度及预后的关系  

Relationships of serum angiopoietin-like protein 4 and fibroblast growth factor 23 levels with severity and prognosis of patients with diabetes nephropathy

作　　者：胡乐乐 魏银宇 王金艳 朱坤良 刘国英 HU Lele;WEI Yinyu;WANG Jinyan;ZHU Kunliang;LIU Guoying(Cangzhou Central Blood Station of Hebei Province,Cangzhou,Hebei,061000;Cangzhou Central Hospital of Hebei Province,Cangzhou,Hebei,061000;Botou Hospital of Hebei Province,Cangzhou,Hebei,062150)

机构地区：[1]河北省沧州市中心血站,河北沧州061000 [2]河北省沧州市中心医院,河北沧州061000 [3]河北省泊头市医院,河北沧州062150

出　　处：《实用临床医药杂志》2024年第18期56-61,共6页Journal of Clinical Medicine in Practice

基　　金：河北省医学科学研究课题计划项目(20220363)。

摘　　要：目的 探讨血清血管生成素样蛋白4(ANGPTL4)、成纤维细胞生长因子-23(FGF-23)水平与糖尿病肾病患者病情严重程度及预后的关系。方法 选取2018年7月—2020年7月120例糖尿病肾病患者作为研究对象(糖尿病肾病组),根据糖尿病肾病分期标准分为轻症组62例与重症组58例;根据3年内预后情况分为预后良好组94例与预后不良组26例。选取102例糖尿病患者为单纯糖尿病组,81例健康体检志愿者作为对照组。采用酶联免疫吸附实验检测糖尿病肾病患者血清ANGPTL4、FGF-23水平。采用Logistic回归分析筛选患者预后的影响因素,绘制受试者工作特征(ROC)曲线,分析ANGPTL4、FGF-23及两者联合对糖尿病肾病患者病情严重程度及预后评估价值。结果 糖尿病肾病组及单纯糖尿病组的ANGPTL4、FGF-23水平高于对照组,差异有统计学意义(P<0.05);与单纯糖尿病组相比,糖尿病肾病组的ANGPTL4、FGF-23水平增加,差异有统计学意义(P<0.05);与轻症组相比,重症组的ANGPTL4、FGF-23水平增加,差异有统计学意义(P<0.05)。ROC曲线对病情严重程度的评估发现,ANGPTL4、FGF-23以及二者联合诊断的曲线下面积(AUC)分别为0.748、0.781、0.858,联合诊断显著优于FGF-23(Z=2.149,P=0.032)、ANGPTL4(Z=2.886,P=0.004)单独诊断;预后良好组的ANGPTL4、FGF-23水平与预后不良组相比显著降低(P<0.05);不同预后糖尿病肾病患者的糖尿病病程、血尿素氮(BUN)、血清肌酐(Scr)、空腹血糖(FBG)、糖化血红蛋白(HbA1C)、高血压以及ANGPTL4、FGF-23水平差异有统计学意义(P<0.05);Scr、ANGPTL4、FGF-23水平均为影响糖尿病肾病预后的危险因素(P<0.05);ROC曲线对患者预后评估发现,ANGPTL4、FGF-23以及二者联合诊断的AUC分别为0.774、0.795、0.874,联合诊断显著优于FGF-23(Z=2.385,P=0.171)、ANGPTL4(Z=2.317,P=0.021)单独诊断。结论 糖尿病肾病患者血清ANGPTL4、FGF-23水平显著升高,二者对糖尿病肾病患者的临床诊�Objective To investigate the relationships of serum angiopoietin-like protein 4(ANGPTL4) and fibroblast growth factor-23(FGF-23) levels with the severity and prognosis of patients with diabetic nephropathy.Methods A total of 120 patients(diabetic nephropathy group) with diabetic nephropathy were selected from July 2018 to July 2020 and divided into mild group(n=62) and severe group(n=58) according to the staging criteria of diabetic nephropathy;based on the prognosis within 3 years,they were also divided into good prognosis group(n=94) and poor prognosis group(n=26).Additionally,102 diabetic patients were enrolled as diabetic group,and 81 healthy volunteers were selected as control group.The serum levels of ANGPTL4 and FGF-23 in diabetic nephropathy patients were detected by enzyme-linked immunosorbent assay(ELISA).Logistic regression analysis was used to analyze the influencing factors of prognosis,and receiver operating characteristic(ROC) curves were drawn to analyze the values of ANGPTL4,FGF-23 and their combination in assessing the severity and prognosis of diabetic nephropathy.Results The levels of ANGPTL4 and FGF-23 in the diabetic nephropathy group and simple diabetic group were significantly higher than those in the control group(P < 0.05);compared with the simple diabetic group,the levels of ANGPTL4 and FGF-23 in the diabetic nephropathy group were significantly increased(P < 0.05);the levels of ANGPTL4 and FGF-23 in the severe group were significantly higher than those in the mild group(P < 0.05);the ROC curve analysis revealed that the areas under the curve(AUCs) for assessing disease severity of ANGPTL4,FGF-23 and their combination were 0.748,0.781 and 0.858 respectively,and the combined diagnosis was significantly better than FGF-23(Z = 2.149,P = 0.032) and ANGPTL4(Z = 2.886,P = 0.004)alone;the levels of ANGPTL4 and FGF-23 in the good prognosis group were significantly lower than those in the poor prognosis group(P < 0.05);significant differences were observed in diabetes duration,blood urea nitroge

关 键 词：糖尿病肾病 血管生成素样蛋白4 成纤维细胞生长因子-23 病情严重程度 预后 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学] R446.11[医药卫生—临床医学]