目的 探讨可溶性转铁蛋白受体(sTfR)、肿瘤坏死因子受体(TNFR)与糖尿病肾病(DN)的相关性及临床意义.方法 选取2020年5月至2022年5月在本院收治的50例DN患者作为DN组,同期收治50例单纯2型糖尿病患者作为糖尿病组,另选50例体检健康者作为健康组.分析并比较三组患者的一般资料,采用多因素logistic回归模型研究影响DN的风险因素,采用Pearson检验进行相关性分析,比较不同DN病情进展程度患者(分为尿蛋白正常组、微量蛋白尿组和大量蛋白尿组)的TNFRl、TNFR2、sTfR水平差异,采用受试者工作特征(ROC)曲线评估TNFRl、TNFR2、sTfR预测DN的效能.结果 与健康组比较,糖尿病组、DN组的总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、24 h尿白蛋白排泄率(24 h UAER)、TNFRl、TNFR2、sTfR增高,而高密度脂蛋白胆固醇(HDL-C)、估算肾小球滤过率(eGFR)降低(均P＜0.05).与糖尿病组比较,DN 组的糖尿病病程、24 h UAER、TNFRl、TNFR2、sTfR 增高,而 eGFR 降低(均 P＜0.05).logistic回归分析结果显示,糖尿病病程、24 h UAER、eGFR、TNFRl、TNFR2、sTfR是发生DN的影响因素(均P＜0.05).微量蛋白尿组的TNFRl、TNFR2、sTfR高于尿蛋白正常组(均P＜0.05).大量蛋白尿组的TNFRl、TNFR2、sTfR高于微量蛋白尿组(均P＜0.05).TNFRl、TNFR2、sTfR与DN风险及病情进展均呈正相关(均P＜0.05).三项指标联合应用时,其预测效能(AUC=0.882)高于各指标单独应用及两项指标联合应用,预测灵敏度及特异度为68.05％、87.95％,临界点分别为 109.16 pg/mL、381.31 pg/mL、1.41 mg/L.结论 TNFR1、TNFR2、sTfR 在 DN 患者的外周血中明显上调,均为DN发病的危险因素,三者联合预测DN时具有较高的灵敏度与特异度,有望成为临床评价DN风险及疾病进展的新指标.
Correlation of soluble transferrin receptor and tumor necrosis factor receptor with diabetic ne-phropathy and their clinical significance
Objective To explore the correlation of soluble transferrin receptor(sTfR)and tumor necrosis factor receptor(TNFR)with diabetic nephropathy(DN)and their clinical signifi-cance.Methods Fifty cases of DN patients admitted to our hospital from May 2020 to May 2022 were selected as DN group,50 cases of type 2 diabetes patients without DN were concurrently set as diabetes group,and 50 individuals receiving health checkups were enrolled as healthy group.The general data were compared among three groups.Multivariate logistic regression model was utilized to identify fac-tors influencing DN.Pearson correlation test was used to examine the correlation between variables.TNFRl,TNFR2,and sTfR levels were compared among patients of different stages of DN(normal group,microalbuminuria group and macroalbuminuria group).Then the receiver operating characteris-tic(ROC)curve was plotted to evaluate the efficacy of TNFRl,TNFR2,and sTfR in predicting DN.Results An increase in total cholesterol(TC),total triglycerides(TG),low density lipoprotein cho-lesterol(LDL-C),fasting blood glucose,glycated hemoglobin(HbAlc),homeostasis model assess-ment(HOMA-IR),24-hour urinary albumin excretion rate(24 h UAER),TNFRl,TNFR2,and sTfR,along with a reduction in high density lipoprotein cholesterol(HDL-C)and estimated glomerular filtration rate(eGFR)were observed in diabetes group and DN group compared to healthy group,with statistical difference(all P＜0.05).DN group reported a longer diabetes duration,higher 24 h UAER,TNFRl,TNFR2,and sTfR,and lower eGFR compared to diabetes group,with statistical difference(all P＜0.05).Logistic regression analysis revealed that diabetes duration,24 h UAER,eGFR,TNFRl,TNFR2,and sTfR were influencing factors in the development of DN(all P＜0.05).TNFRl,TNFR2,and sTfR levels were the highest in macroalbuminuria group,followed by microalbu-minuria group,and were the lowest in normal albuminuria group,with statistical difference(all P＜0.05).TNFRl,TNFR2 and sTfR were positively correlated with DN development and progression risk(all P＜0.05).A cut-off value of 109.16 pg/mL,381.31 pg/mL and 1.41 mg/L for serum TNFRl,TNFR2,and sTfR resulted an area under the curve(AUC)of 0.882,sensitivity of 68.05％and spe-cificity of 87.95％in the prediction of DN development and progression through combined test,which was larger than the those of separate test.Conclusions TNFRl,TNFR2,and sTfR are abnormally up-regulated in peripheral blood of DN patients,and the three are risk factors for the development of DN.Furthermore,the combined test of three indicators has high sensitivity and specificity in the prediction of DN,and the three are expected to be new indicators for the clinical evaluation of the risk of DN and the progression of the disease.
万方数据
维普
