TEG相关参数联合血清Hcy在2型糖尿病肾脏病变中的应用价值  

The application value of TEG related parameters combined with serum Hcy in type 2 diabetes mellitus complicated by kidney lesions

作　　者：应子薇 周广举[1] YING Ziwei;ZHOU Guangju(Department of Endocrinology,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]川北医学院附属医院内分泌科,四川南充637000

出　　处：《检验医学与临床》2025年第8期1100-1105,共6页Laboratory Medicine and Clinic

基　　金：四川省基层卫生事业发展研究中心科研创新项目(SWFZ23-W-01)。

摘　　要：目的探讨血栓弹力图(TEG)相关参数联合血清同型半胱氨酸(Hcy)在2型糖尿病(T2DM)肾脏病变中的应用价值。方法回顾性选取2020年1月至2022年12月在该院确诊的120例T2DM住院患者,根据尿清蛋白与肌酐比值(UACR)和估算肾小球滤过率(eGFR)将患者分为单纯性糖尿病组[UACR<30 mg/g且eGFR≥90 mL/(min·1.73 m^(2)),以下简称为DM组]、早期糖尿病肾病组[30 mg/g≤UACR<300 mg/g且60 mL/(min·1.73 m^(2))≤eGFR<90 mL/(min·1.73 m^(2)),以下简称为eDKD组]和临床期糖尿病肾病组[UACR≥300 mg/g且eGFR<60 mL/(min·1.73 m^(2)),以下简称为cDKD组]。比较各组临床资料。采用Pearson相关分析糖尿病肾病(DKD)患者UACR与血清Hcy水平、TEG相关参数的相关性。采用多因素Logistic回归分析T2DM患者发生DKD的影响因素。绘制受试者工作曲线(ROC)分析血清Hcy、TEG相关参数单独及联合检测对T2DM患者发生DKD的预测价值。结果cDKD组入院首日的收缩压(SBP)、UACR、胱抑素C(CysC)、尿酸(UA)水平高于eDKD组、DM组,且eDKD组高于DM组,差异均有统计学意义(P<0.05)。cDKD组血清Hcy水平及凝血形成速率(Angel)、凝血最终强度(MA)、凝血综合指数(CI)高于DM组、eDKD组,凝血形成时间(K)短于DM组、eDKD组,差异均有统计学意义(P<0.05)。eDKD组血清Hcy水平及Angle、MA、CI高于DM组,K短于DM组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,DKD患者UACR与K呈负相关(r=-0.486,P<0.05),与血清Hcy水平及Angle、MA、CI均呈正相关(r=0.511、0.470、0.586、0.455,P<0.05)。多因素Logistic回归分析结果显示,血清Hcy水平及入院首日SBP、Angle、MA升高,K缩短是T2DM患者发生DKD的危险因素(P<0.05)。ROC曲线分析结果显示,4项指标联合预测的曲线下面积(AUC)为0.882,大于血清Hcy及K、Angle、MA单独检测的AUC(Z=2.020、2.809、2.989、2.361,P=0.043、0.005、0.003、0.018)。结论在DKD患者中K缩短,Angle、MA及血清Hcy水平升高,与患者疾病进展Objective To explore the application value of thromboelastogram(TEG)related parameters combined with serum homocysteine(Hcy)in type 2 diabetes mellitus(T2DM)complicated by kidney lesions.Methods A total of 120 inpatients with T2DM diagnosed in the hospital from January 2020 to December 2022 were retrospectively selected.According to the urine albumin to creatinine ratio(UACR)and estimated glomerular filtration rate(eGFR),the patients were divided into the simple diabetes mellitus group[UACR<30 mg/g and eGFR≥90 mL/(min·1.73 m^(2)),abbreviated as the DM group],the early diabetic kidney disease group[30 mg/g≤UACR<300 mg/g and 60 mL/(min·1.73 m^(2))≤eGFR<90 mL/(min·1.73 m^(2)),abbreviated as the eDKD group],and the clinical diabetic kidney disease group[UACR≥300 mg/g and eGFR<60 mL/(min·1.73 m^(2)),abbreviated as the cDKD group].Compare the clinical data of each group.Pearson correlation analysis was used to analyze the correlation between UACR and the levels of serum Hcy,as well as TEG related parameters in patients with diabetic nephropathy(DKD).Multivariate Logistic regression analysis was employed to analyze the influencing factors of the occurrence of DKD in patients with T2DM.The receiver operating characteristic curve(ROC)was plotted to analyze the predictive value of the separate and combined detections of serum Hcy and TEG related parameters for the occurrence of DKD in patients with T2DM.Results The levels of first admission systolic blood pressure(SBP),UACR,cystatin C(CysC),and uric acid(UA)in the cDKD group were higher than those in the eDKD group and the DM group,and those in the eDKD group were higher than those in the DM group,and the differences were statistically significant(P<0.05).The levels of serum Hcy,coagulation formation rate(Angel),final coagulation strength(MA),and comprehensive coagulation index(CI)in the cDKD group were higher than those in the DM group and the eDKD group,and the coagulation formation time(K)was shorter than that in the DM group and the eDKD group(P<0.05).The l

关 键 词：2型糖尿病 糖尿病肾病 同型半胱氨酸 血栓弹力图 尿清蛋白与肌酐比值 

分 类 号：R587.2[医药卫生—内分泌] R446.11[医药卫生—内科学]