血清Nrg4、Glypican-4检测对糖尿病肾病病情评估的价值  

Value of serum Nrg4 and Glypican-4 in the evaluation of diabetic kidney disease

作　　者：田亚平 李立琴[2] TIAN Ya-ping;LI Li-qin(Graduate School of Chengde Medical College,Chengde 067000,Hebei,CHINA;Department of Endocrinology,Baoding First Central Hospital,Baoding 071000,Hebei,CHINA)

机构地区：[1]承德医学院研究生学院,河北承德067000 [2]保定市第一中心医院内分泌科,河北保定071000

出　　处：《海南医学》2024年第23期3415-3419,共5页Hainan Medical Journal

摘　　要：目的检测2型糖尿病(T2DM)患者的血清神经调节蛋白4(Nrg4)、磷脂酰肌醇蛋白聚糖4(Glypican-4)水平并探讨其对糖尿病肾病病情评估的价值。方法前瞻性选取2023年9月至2024年6月于保定市第一中心医院收治的121例T2DM患者纳入研究,根据尿白蛋白/肌酐比值(UACR)将T2DM患者分为正常白蛋白尿组42例(A1组,UACR<30 mg/g)、微量白蛋白尿组40例(A2组,30≤UACR<300 mg/g)和大量白蛋白尿组39例(A3组,UACR≥300 mg/g),并选取于该院同期体检的44例健康成年人作为正常对照组(NC组)。采用Spearman相关分析血清Nrg4、Glypican-4水平与实验室有关检测指标的关系,采用多因素Logistic回归分析血清Nrg4、Glypican-4对糖尿病肾病的影响,建立受试者工作特征(ROC)曲线评估血清Nrg4、Glypican-4单独以及联合检测对早期糖尿病肾病的诊断价值。结果NC组、A1组、A2组、A3组受检者的血清Nrg4水平依次降低,Glypican-4水平依次升高,各组间比较差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,血清Nrg4水平与总蛋白、白蛋白、肾小球滤过率呈正相关(P<0.05),与糖化血红蛋白、甘油三酯、空腹静脉血糖、空腹胰岛素、胰岛素抵抗指数、血肌酐、24 h尿蛋白、尿微量白蛋白、UACR、尿白蛋白排泄率、Glypican-4呈负相关(P<0.05),而血清Glypican-4水平与糖化血红蛋白、体质量指数、甘油三酯、空腹静脉血糖、空腹胰岛素、胰岛素抵抗指数、血肌酐、24 h尿蛋白、尿微量白蛋白、UACR、尿白蛋白排泄率呈正相关(P<0.05),与总蛋白、白蛋白、肾小球滤过率呈负相关(P<0.05)。多因素Logistic回归分析显示Nrg4、Glypican-4、24 h尿蛋白、白蛋白是糖尿病肾病的影响因素。ROC曲线分析结果显示,血清Nrg4和Glypican-4两者联合检测对糖尿病肾病早期诊断的AUC为0.863,高于血清Nrg4、Glypican-4单独检测(AUC分别为0.817、0.706)。结论随着糖尿病肾病病情进展,血清Nrg4水�Objective To detect serum levels of Neuregulin 4(Nrg4)and Glypican-4 in patients with type 2 di-abetes mellitus(T2DM)and to investigate their value in the assessment of diabetic kidney disease.Methods A total of 121 type 2 diabetes mellitus(T2DM)patients admitted to Baoding First Central Hospital from September 2023 to June 2024 were prospectively selected for inclusion in the study.According to the urine albuminuria/creatinine ratio(UACR),patients with T2DM were divided into 42 cases in the normal albuminuria group(group A1,UACR<30 mg/g),40 cases in the microalbuminuric group(group A2,30≤UACR<300 mg/g),and 39 cases in the macroalbuminuric group(group A3,UACR≥300 mg/g).Forty-four healthy adults who underwent medical examination suring the same period at the hospital were selected as the normal control group(NC group).Spearman correlation was used to analyze the relation-ship between serum Nrg4 and Glypican-4 levels and laboratory detection indicators.Multivariate logistic regression analysis was used to analyze the effect of serum Nrg4,Glypican-4 on diabetic kidney disease.Receiver operating charac-teristic(ROC)curve was used to assess the diagnostic value of serum Nrg4 and Glypican-4 alone and in combination for early diabetic kidney disease.Results The serum Nrg4 level of the subjects in group NC,group A1,group A2,and group A3 decreased sequentially,and the Glypican-4 level increased sequentially in the same order,with statistically sig-nificant differences among the four groups(P<0.05).Spearman correlation analysis showed that serum Nrg4 levels were positively correlated with total protein,albumin,and estimated glomerular filtration rate(P<0.05),and negatively corre-lated with hemoglobin A1c,triglyceride,fasting blood glucose,fasting plassma insulin,insulin resistance index,serum creatinine,24 h urine protein,urine microalbumin,UACR,urinary albumin excretion rate,and Glypican-4(P<0.05).Se-rum Glypican-4 levels were positively correlated with hemoglobin A1c,body mass index,triglyceride,fasting blood glu-cos

关 键 词：糖尿病肾病 2型糖尿病 神经调节蛋白4 磷脂酰肌醇蛋白聚糖4 病情评估 

分 类 号：R587.2[医药卫生—内分泌]