摘要
目的分析血清铜蓝蛋白(ceruloplasmin,CERP)、血清铁蛋白(serum ferritin,SF)、α-Klotho、成纤维细胞生长因子-23(fibroblast growth factor,FGF-23)在2型糖尿病患者白蛋白尿进展中的预测价值。方法选择2020年6月至2022年5月沭阳医院内分泌科因控制血糖重复收住院的120例2型糖尿病患者进行回顾性队列研究,将首次住院和第二次住院的资料分别作为基线资料和随访资料。根据基线中患者白蛋白尿情况将其分为3组:无白蛋白尿组、微量白蛋白尿组、大量白蛋白尿组,比较3组患者中CERP、SF、α-Klotho、FGF-23水平的差异;根据随访资料评价白蛋白尿进展的情况,比较白蛋白尿进展的患者与未进展的患者的基线临床资料及其CERP、SF、α-Klotho、FGF-23水平的差异,采用logistic回归分析白蛋白尿进展的影响因素,采用ROC曲线分析白蛋白尿进展的预测指标。结果随着2型糖尿病患者尿白蛋白水平升高,血清CERP、SF、FGF-23水平升高,而α-Klotho水平降低(P<0.05);白蛋白尿进展的2型糖尿病患者的糖尿病病程长于未进展的2型糖尿病患者,其二甲双胍及SGLT2抑制剂(SGLT2i)使用比例、α-Klotho水平均低于未进展的2型糖尿病患者,其高血压比例、FBG、UA、CERP、SF、FGF-23水平均高于未进展的2型糖尿病患者,差异有统计学意义(P<0.05);logistic回归分析显示CERP、SF、FGF-23水平升高是白蛋白尿进展的危险因素,而使用二甲双胍及SGLT2i以及α-Klotho水平的升高均是白蛋白尿进展的保护因素;ROC曲线分析显示首次住院时血清CERP、SF、α-Klotho、FGF-23的水平对白蛋白尿进展具有预测价值,logistic回归方程的联合指标预测尿白蛋白的灵敏度和特异性均优于单一指标。结论血清CERP、SF、FGF-23水平的升高及α-Klotho水平的降低与2型糖尿病患者中白蛋白尿进展有关,检测4项血清指标对白蛋白尿进展具有预测价值。
Objective To analyze the values of serum CERP,SF,α-Klotho and FGF-23 in predicting the progression of albuminuria in patients with type 2 diabetes(T2D).Methods A total of 120 patients with T2D repeatedly admitted to the Department of Endocrinology of Shuyang Hospital for blood glucose control from June 2020 to May 2022 were selected for the retrospective cohort study.The hospitalization data during the index hospitalization and the readmission were used as the baseline data and follow-up data respectively.Patients were divided into 3 groups:non-albuminuria group,micro-albuminuria group,macro-albuminuria group,according to the albuminuria level of baseline data.The levels of CERP,SFα-Klotho and FGF-23 in patient of different groups were compared.The progression of albuminuria was evaluated according to the follow-up data,and the baseline clinical data and levels of CERP,SF,α-Klotho,FGF-23 between patients with and without albuminuria were compared.The influencing factors of albuminuria progression were analyzed by logistic regression,and the predictive indicators of albuminuria progression were analyzed by ROC curve.Results The levels of CERP,SF and FGF-23 were increased and the level ofα-Klotho was decreased with the increase of the albuminuria level in T2D patients(P<0.05).The duration of diabetes in the T2D patients with albuminuria progression was longer than that in the T2D patients without albuminuria progression.The proportions of using metformin and SGLT2 inhibitor(SGLT2i)and the level ofα-Klotho in the T2D patients with albuminuria progression were lower than those in the T2D patients without albuminuria progression,and the proportion of hypertension,the levels of FBG,UA,CERP,SF and FGF-23 in the T2D patients with albuminuria progression were higher than those in the T2D patients without albuminuria progression(P<0.05).Logistic regression analysis showed that the elevated levels of CERP,SF and FGF-23 were risk factors for the progression of albuminuria,the use of metformin and SGLT2i and the increase ofα-Klotho level were protective factors for the progression of albuminuria.ROC curve analysis showed that the levels of serum CERP,SF,α-Klotho and FGF-23 had predictive values for the development of albuminuria,the sensitivity and specificity by using the combined index in predicting the progression of albuminuria were both higher than those by using single indexes.Conclusion Increased levels of serum CERP,SF,FGF-23 and decreased level ofα-Klotho are related with the development of albuminuria in T2D patients.Those four serum indicators have predictive values for the progression of albuminuria.
作者
张前进
胡金娥
胡一川
ZHANG Qianjin;HU Jin’e;HU Yichuan(Department of Endocrinology,the Affiliated Shuyang Hospital of Xuzhou Medical University,Suqian,Jiangsu,223600,China)
出处
《医学分子生物学杂志》
CAS
2024年第1期51-56,共6页
Journal of Medical Molecular Biology
基金
2020年度宿迁市指导性科技计划项目(No.Z2020061)。
