摘要
目的探讨超重或肥胖2型糖尿病(T2DM)患者成纤维细胞生长因子21(FGF21)水平与微血管并发症的关系。方法选取2017年8月至2020年2月该院内分泌科住院的超重或肥胖T2DM患者378例,根据血清FGF21水平分为低FGF21组(<298 ng/mL)、中FGF21组(298~419 ng/mL)和高FGF21组(>419 ng/mL),每组126例。分析3组患者血清FGF21水平与体重指数(BMI)、T2DM病程、糖化血红蛋白(HbA1c)、三酰甘油(TG)、空腹血清C肽(FCP)、尿清蛋白肌酐比值(UACR)、胰岛素抵抗指数(HOMA-IR)、C反应蛋白(CRP)、高密度脂蛋白胆固醇(HDL-C)、肾小球滤过率估计值(eGFR),以及糖尿病肾病(DN)、糖尿病视网膜病变(DR)的相关性,预测血清FGF21水平对DN和DR的诊断价值。结果低、中、高FGF21组患者BMI、T2DM病程、HbA1c、TG、FCP、UACR、HOMA-IR、CRP水平,以及DN和DR患病率依次增加,HDL-C水平和eGFR依次下降,差异均有统计学意义(P<0.05)。FGF21水平与BMI、T2DM病程、HbA1c、TG、FCP水平、UACR、HOMA-IR、CRP水平均呈正相关(P<0.05),与HDL-C、eGFR均呈负相关,差异均有统计学意义(P<0.05)。随FGF21水平增加,DN高分期和DR高分级患者比例越大,差异均有统计学意义(P<0.05)。T2DM病程、HbA1c、TG、UACR、FGF21均是导致DN和DR发生的独立危险因素,HDL-C则是DN和DR发生的保护因素(P<0.05)。血清FGF21水平诊断DN和DR的受试者工作特征曲线下面积分别为0.883、0.899,最佳临界值分别为456.51、450.00 ng/mL,灵敏度分别为83.1%、84.1%,特异度分别为95.3%、95.2%。结论DN和DR患者血清FGF21水平均升高,血清FGF21水平是DN和DR的独立危险因素,可能参与了二者的发病和进展,可作为潜在的生物学诊断指标。
Objective To explore the relationship between the levels of fibroblast growth factor 21(FGF21)and microvascular complications in obese or overweight patients with type 2 diabetes mellitus(T2DM).Methods A total of 378 obese and overweight T2DM patients hospitalized in the endocrinology department of this hospital from August 2017 to February 2020 were selected and divided into the low FGF21 group(<298 ng/mL),middle FGF21 group(<298 ng/mL)and high FGF21 group(>419 ng/mL)according to serum FGF21 level,126 cases in each group.The correlation between serum FGF21 level with BMI,T2DM course,HbA1c,triglyceride(TG),fasting c-peptide(FCP),urinary albumin creatinine ratio(UACR),HOMA-insulin resistance(HOMA-IR),C reactive protein(CRP),HDL-C eGFR,diabetic nephropathy(DN)and diabetic retinopathy(DR)in the three groups was analyzed.The diagnostic value of serum FGF21 level to DN and DR was predicted.Results In the patients with low,medium and high FGF21 levels,BMI,T2DM course,HbA1c,TG,FCP,urinary albumin creatinine ratio(UACR),HOMA-insulin resistance(HOMA-IR),CRP,and morbidity rate of DN and DR were increased in turn,the HDL-C and eGFR levels were decreased,and thedifferences were statistically significant(P<0.05).The FGF21 level had significantly positive correlation with BMI,T2DM course,HbA1c,TG,FCP,UACR,HOMA-IR and CRP levels(P<0.05),had negatively correlation with HDL-C and eGFR,and the differences were statisticaly significant(P=0.000).With the increase of FGF21 level,the proportions of the patients with DN high stage and DR high grade were greater,and the difference was statistically significant(P<0.05).The T2DM course,HbA1c,TG,UACR and FGF21 all were the independent risk factors for the occurrence of DN and DR,while HDL-C was the protective factor for the occurrence of DN and DR(P<0.05).The area under the ROC curve of serum FGF21 level for diagnosing DN and DR was 0.883 and 0.899,respectively,and the optimal cut-off values were 456.51 ng/mL and 450.00 ng/mL,the sensitivities were 83.1%and 84.1%respectively,and specificities were 95.3%and 95.2%respectively.Conclusion Serum FGF21 level is increased in the patients with DN and DR.Serum FGF21 level is an independent risk factor for DN and DR,which may be involved in the pathogenesis and progression of both,and could serve as a potential biological diagnostic indicator.
作者
李健
余兰
周宇
殷小华
王艳立
钟智丹
吴嘉俐
LI Jian;YU Lan;ZHOU Yu;YIN Xiaohua;WANG Yanli;ZHONG Zhidan;WU Jiali(Department of Endocrinology,Zigong Municipal First People’s Hospital,Zigong,Sichuan 643000,China)
出处
《重庆医学》
CAS
2022年第13期2216-2221,2226,共7页
Chongqing medicine
基金
四川省卫生健康委员会普及应用研究项目(19PJ310)。
关键词
肥胖
超重
2型糖尿病
成纤维细胞生长因子21
微血管并发症
obese
overweight
type 2 diabetes mellitus
fibroblast growth factor 21
microvascular complications
