新诊断2型糖尿病患者血清Lp-PLA2、NGAL及尿ACR水平对早期肾脏损伤的诊断价值  

Diagnostic Value of Serum Lp-PLA2,NGAL and Urinary ACR Levels in Newly Diagnosed Type 2 Diabetes Patients for Early Renal Injury

作　　者：石琳娜 卢一 蒋跃 龚利花 陈玉立 SHI Linna;LU Yi;JIANG Yue;GONG Lihua;CHEN Yuli(Department of endocrinology,Nanjing Qixia District Hospital,Qixia District,Nanjing 210046,China;Internal medicine,Nanjing Qixia District Hospital,Qixia District,Nanjing 210046,China;Clinical laboratory,Nanjing Qixia District Hospital,Qixia District,Nanjing 210046,China)

机构地区：[1]南京市栖霞区医院内分泌科,南京210046 [2]南京市栖霞区医院内科,南京210046 [3]南京市栖霞区医院检验科,南京210046

出　　处：《转化医学杂志》2024年第6期908-913,共6页Translational Medicine Journal

基　　金：南京市医学科技发展一般性课题项目(YKK22215)。

摘　　要：目的探究新诊断2型糖尿病(T2DM)患者血清脂蛋白相关性磷脂酶A2(Lp-PLA2)、中性粒细胞明胶酶相关载脂蛋白(NGAL)及尿蛋白/肌酐比值(ACR)水平对早期肾脏损伤的诊断价值。方法选取2022年9月至2024年9月南京市栖霞区医院收治的153例T2DM合并肾损伤患者及153例单纯T2DM患者为研究对象,分别纳入T2DM+肾损伤组和T2DM组,采用ELISA法检测2组患者血清Lp-PLA2、NGAL水平,采用免疫比浊法检测2组患者尿蛋白,采用比色法检测两组患者尿肌酐水平,并计算2组患者ACR水平;采用Pearson法分析Lp-PLA2、NGAL、ACR水平与临床资料的相关性;采用多因素Logistic分析T2DM患者早期肾损伤的影响因素;采用ROC曲线分析LpPLA2、NGAL、ACR水平对T2DM患者早期发生肾脏损伤的诊断价值。结果T2DM+肾损伤组患者病程年限、HbA1c、Scr、CysC、BUN显著高于T2DM组,eGFR显著低于T2DM组(P<0.05)。T2DM+肾损伤组患者血清LpPLA2、NGAL水平及尿ACR显著高于T2DM组(P<0.05)。Lp-PLA2、NGAL、ACR水平与eGFR水平呈负相关,与病程年限、HbA1c、Scr、CysC、BUN水平呈正相关(P<0.05)。病程年限、HbA1c、Scr、CysC、BUN、Lp-PLA2、NGAL、ACR的OR值分别为2.248、2.649、3.125、3.638、2.657、3.642、4.237、4.516,均为T2DM患者肾损伤的危险因素,eGFR的OR值为0.422,为T2DM患者肾损伤的保护因素(P<0.05)。Lp-PLA2、NGAL、ACR三者联合诊断T2DM患者早期肾脏损伤的AUC高于Lp-PLA2(Z=5.466,P<0.05)、NGAL(Z=5.930,P<0.05)、ACR(Z=4.709,P<0.05)单一诊断的AUC。结论T2DM患者血清Lp-PLA2、NGAL及尿ACR上调表达,三者联合对T2DM早期肾损伤的诊断价值较高。Objective To explore the diagnostic value of serum lipoprotein associated phospholipase A2(Lp-PLA2),neutrophil gelatinase-associated lipocalin(NGAL)and albumin/creatinine ratio(ACR)levels in newly diagnosed type 2 diabetes mellitus patients for early renal injury.Methods From September 2022 to September 2024,153 patients with T2DM complicated with renal injury and 153 patients with simple T2DM admitted to Nanjing Qixia district hospital were regarded as the study subjects,and were included in the T2DM+renal injury group and T2DM group,respectively.ELISA method was applied to detect the serum levels of Lp-PLA2 and NGAL in two groups.Immunoturbidimetry was applied to detect urinary protein in two groups.The colorimetric method was applied to detect the urinary creatinine level of two groups,and the ACR of the two groups were calculated.Pearson method was applied to analyze the correlation between Lp-PLA2,NGAL,ACR levels and clinical data.Multivariate logistic regression was applied to analyze the influencing factors of early renal injury in T2DM patients.ROC curve was applied to analyze the diagnostic value of Lp-PLA2,NGAL,and ACR levels for early renal injury in T2DM patients.Results Patients in the T2DM+renal injury group had significantly more years of disease duration,HbA1c,Scr,CysC,and BUN than those in the T2DM group,and eGFR was significantly lower than those in the T2DM group(P<0.05).The levels of serum Lp-PLA2,NGAL,and urinary ACR in the T2DM+renal injury group were obviously higher than those in the T2DM group(P<0.05).The levels of Lp-PLA2,NGAL,ACR were negatively correlated with eGFR level,and positively correlated with disease duration,HbA1c,Scr,CysC,and BUN levels(P<0.05).TheORof disease duration,HbA1c,Scr,CysC,BUN,Lp-PLA2,NGAL,and ACR were 2.248,2.649,3.125,3.638,2.657,3.642,4.237,and4.516,were identified as risk factors for renal injury in T2DM patients,,and theORof 0.422 for eGFR,serving as a protective factor for renal injury in T2DM patients(allP<0.05).The AUC of the combination of Lp-PLA2,NGAL,an

关 键 词：2型糖尿病 脂蛋白相关性磷脂酶A2 中性粒细胞明胶酶相关载脂蛋白 尿蛋白/肌酐比值 早期肾脏损伤 诊断 

分 类 号：R587.2[医药卫生—内分泌] R446.112[医药卫生—内科学]