目的 探讨血清血清胎球蛋白A(Fetuin-A)联合脂肪酸结合蛋白4(fatty acid binding protein 4，FABP4)预测2型糖尿病患者糖尿病肾病发病风险的价值。方法 选取2021年8月至2023年7月西安工会医院收治的2型糖尿病患者107例，男55例，女52例，年龄(61。69±9。05)岁。根据尿白蛋白/肌酐比值将患者分为正常白蛋白尿组48例、微量白蛋白尿组39例、大量白蛋白尿组20例。选择50例健康体检者作为健康对照组，男26例，女24例，年龄(60。87±8。24)岁。比较各组基本资料、FABP4、Fetuin-A、C反应蛋白(C-reactive protein，CRP)、脂联素水平和血脂血糖相关指标水平。采用方差分析、LSD-t检验、x2检验。结果 正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组患者体质量指数(body mass index，BMI)分别为(24。35±3。04)kg/m2、(25。06±3。12)kg/m2、(24。88±2。83)kg/m2，均高于健康对照组的(22。48±2。83)kg/m2(均P＜0。05);正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组患者血清 FABP4 水平分别为(7。92±1。76)μg/L、(8。46±1。98)μg/L、(9。23±2。05)μg/L，Fetuin-A 水平分别为(330。67±44。32)mg/L、(385。38±49。15)mg/L、(413。10±56。28)mg/L，CRP 水平分别为(4。77±1。34)mg/L、(5。83±1。96)mg/L、(6。59±2。17)mg/L，均高于健康对照组的(6。77±1。32)μg/L、(224。56±31。93)mg/L、(2。36±1。11)mg/L(均P＜0。05)，脂联素水平分别为(7。56±2。31)mg/L、(5。21±2。09)mg/L、(4。33±1。95)mg/L，低于健康对照组的(11。12±2。43)mg/L(均P＜0。05);正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组患者空腹血糖(fasting blood glucose，FBG)分别为(8。23±2。79)mmol/L、(8。48±3。18)mmol/L、(8。51±3。26)mmol/L，糖化血红蛋白(glycosylated hemoglobin，type A1C，HbA1c)分别为(8。79±1。35)％、(8。96±1。47)％、(9。04±1。52)％，低密度脂蛋白胆固醇(low density lipoprotein cholesterol，LDL-C)分别为(3。35±0。71)mmol/L、(3。26±0。72)mmol/L、(3。51±0。77)mmol/L，总胆固醇(total cholesterol，TC)分别为(5。15±0。97)mmol/L、(5。08±0。95)mmol/L、(5。18±0。97)mmol/L，三酰甘油(triacylglycerol，TG)水平分别为(1。69±0。73)mmol/L、(1。82±0。85)mmol/L、(1。84±0。79)mmol/L，均高于健康对照组的(4。52±0。67)mmol/L、(5。18±1。03)％、(2。28±0。57)mmol/L、(4。52±0。85)mmol/L、(1。24±0。42)mmol/L(均 P＜0。05)，高密度脂蛋白胆固醇(high density lipoprotein cholesterol，HDL-C)水平分别为(1。12±0。47)mmol/L、(1。15±0。50)mmol/L、(1。17±0。48)mmol/L，低于健康对照组的(1。36±0。28)mmol/L(P=0。030);正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组患者餐后2 h血糖差异无统计学意义(P＞0。05);2型糖尿病患者肾病发病风险随着血清Fetuin-A、FABP4水平升高而增加(均P＜0。05);血清Fetuin-A联合FABP4预测2型糖尿病患者肾病发病风险的曲线下面积(AUC)为0。873(95％CI0。782～0。963，P＜0。001)，灵敏度85。17％，特异度84。44％。结论 血清Fetuin-A联合FABP4预测2型糖尿病患者肾病发病风险有较高的特异度和灵敏度，具有一定预测价值。
Value of serum Fetuin-A and FABP4 in prediction of nephropathy risk in patients with type 2 diabetes mellitus
Objective To investigate the value of serum Fetuin-A and fatty acid binding protein 4(FABP4)in the prediction of nephropathy risk in patients with type 2 diabetes mellitus.Methods A total of 107 patients with type 2 diabetes mellitus admitted to Xi'an Trade Union Hospital from August 2021 to July 2023 were selected,including 55 males and 52 females who were(61.69±9.05)years old;they were divided into a normal albuminuria group(48 cases),a microalbuminuria group(39 cases),and a macroalbuminuria group(20 cases)according to their urinary albuminuria/creatinine ratios.Fifty healthy examinees were selected as a healthy control group,including 26 males and 24 females who were(60.87±8.24)years old.The basic data and levels of FABP4,Fetuin-A,C-reactive protein(CRP),adiponectin,and blood lipids and glucose related indicators were compared.Analysis of variance,LSD-t test,and x2 test were applied.Results The body mass indexes(BMI)of the normal albuminuria group,the microalbuminuria group,and the macroalbuminuria group were(24.35±3.04)kg/m2,(25.06±3.12)kg/m2,and(24.88±2.83)kg/m2,which were higher than that in the healthy control group[(22.48±2.83)kg/m2](all P＜0.05).The levels of FABP4,Fetuin-A,and CRP of the normal albuminuria group,the microalbuminuria group,and the macroalbuminuria group were(7.92±1.76)μg/L,(8.46±1.98)μg/L,and(9.23±2.05)μg/L,(330.67±44.32)mg/L,(385.38±49.15)mg/L,and(413.10±56.28)mg/L,and(4.77±1.34)mg/L,(5.83±1.96)mg/L,and(6.59±2.17)mg/L,respectively,which were higher than those in the healthy control group[(6.77±1.32)μg/L,(224.56±31.93)mg/L,and(2.36±1.11)mg/L](all P＜0.05);the levels of adiponectin of the normal albuminuria group,the microalbuminuria group,and the macroalbuminuria group were(7.56±2.31)mg/L,(5.21±2.09)mg/L,and(4.33±1.95)mg/L,respectively,which were lower than that in the healthy control group[(11.12±2.43)mg/L](all P＜0.05).The levels of fasting blood glucose(FBG),glycosylated hemoglobin,type A1C(HbA1c),low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),and triacylglycerol(TG)of the normal albuminuria group,the microalbuminuria group,and the macroalbuminuria group were(8.23±2.79)mmol/L,(8.48±3.18)mmol/L,and(8.51±3.26)mmol/L,(8.79±1.35)％,(8.96±1.47)％,and(9.04±1.52)％,(3.35±0.71)mmol/L,(3.26±0.72)mmol/L,and(3.51±0.77)mmol/L,(5.15±0.97)mmol/L,(5.08±0.95)mmol/L,and(5.18±0.97)mmol/L,and(1.69±0.73)mmol/L,(1.82±0.85)mmol/L,and(1.84±0.79)mmol/L,respectively,which were higher than those in the healthy control group[(4.52±0.67)mmol/L,(5.18±1.03)％,(2.28±0.57)mmol/L,(4.52±0.85)mmol/L,and(1.24±0.42)mmol/L](P＜0.001,P＜0.001,P＜0.001,P=0.003,and P＜0.001);the levels of high density lipoprotein cholesterol(HDL-C)of the normal albuminuria group,the microalbuminuria group,and the macroalbuminuria group were(1.12±0.47)mmol/L,(1.15±0.50)mmol/L,and(1.17±0.48)mmol/L,respectively,which were lower than that in the healthy control group[(1.36±0.28)mmol/L](P=0.030).There was no statistical difference in 2 h postprandial blood glucose between the normal albuminuria group,the microalbuminuria group,and the macroalbuminuria group(P＞0.05).The nephropathy risk in the patients increased with the serum levels of Fetuin-A and FABP4(both P＜0.001).The area under the curve(AUC)of Fetuin-A combined with FABP4 in the prediction of nephropathy in the patients was 0.873(95％CI 0.782-0.963,P＜0.001);the sensitivity was 85.17％;specificity was 84.44％.Conclusion Serum Fetuin-A combined with FABP4 has high specificity and sensitivity in predicting the nephropathy risk in patients with type 2 diabetes mellitus,and has certain predictive value.
Type 2 diabetes mellitusSerum Fetuin-AFABP4Diabetic nephropathy
万方数据
维普
