摘要
目的 探讨血红蛋白(Hb)、基质金属蛋白酶-7(MMP-7)水平与老年糖尿病肾病患者肾间质纤维化(RIF)以及进展为终末期肾病(ESRD)的关系.方法 选择2014年4月至2020年4月石家庄市第三医院肾内科收治的103例老年糖尿病肾病患者(肾病组),95例单纯糖尿病患者(糖尿病组),59例体检志愿者为对照组.所有患者均接受Hb、MMP-7、肾功能、RIF血清学指标检测,出院后随访至2022年4月,统计ESRD发生情况.Pearson分析Hb、MMP-7与肾功能、RIF血清学指标的相关性.Kaplan-Meier生存曲线分析不同Hb、MMP-7水平下糖尿病肾病患者肾脏累积存活率.单因素或多因素COX风险比例回归分析老年糖尿病肾病患者ESRD的危险因素.结果 肾病组Hb、估算肾小球滤过率(eOFR)低于对照组(P＜0.05),MMP-7、血肌酐(Scr)、尿素氮(BUN)、转化生长因子(TGF)-β1、TGF-a水平高于对照组(P＜0.05).肾病组Hb与eGFR呈正相关(P＜0.05),与Scr、BUN、TGF-β1、TGF-α呈负相关(P＜0.05),MMP-7与eGFR呈负相关,与Scr、BUN、TGF-β1、TGF-a呈正相关(P＜0.05).低Hb水平组无ESRD累积存活率低于高Hb水平组(P＜0.05),高MMP-7水平组无ESRD累积存活率低于低MMP-7水平组(P＜0.05).多因素COX回归分析结果显示TGF-β1、TGF-a、MMP-7是糖尿病肾病患者ESRD的危险因素(P＜0.05),Hb、eGFR是糖尿病肾病患者ESRD保护因素(P＜0.05).结论 老年糖尿病肾病患者Hb水平降低,血清MMP-7水平增高,且与肾功能下降、RIF以及ESRD发生有关.
Abstract
Objective To investigate the relationship between hemoglobin(Hb)and matrix metalloproteinase-7(MMP-7)levels and renal interstitial fibrosis(RIF)and progression to end-stage renal disease(ESRD)in patients with diabetic nephropathy.Methods 103 diabetic nephropathy patients(nephropathy group)admitted to the department of Nephrology of from April 2014 to April 2020 were selected,and 95 cases of simple diabetes(diabetes group),59 physi-cal examination volunteers were selected as control group.All patients received Hb,MMP-7,renal function,and RIF in-dicators,and were followed up to April 2022 after discharge,and the incidence of end-stage renal disease(ESRD)was analyzed.Pearson analyzed the correlation arnong Hb,MMP-7 and renal function,the serological indicators of RIF.Ka-plan-Meier survival curve was used to analyze the cumulative survival rate of diabetic nephropathy patients with differ-ent levels of Hb and MMP-7.Univariate or multivariate COX proportional hazard regression analysis was used to ana-lyze the risk factors of ESRD in patients with diabetic nephropathy.Results Hb and estimated glomerular filtration rate(eGFR)in nephropathy group were lower than those in control group(P＜0.05),MMP-7,serum creatinine(Scr),blood urea nitrogen(BUN),transforming growth factor(TGF)-β1 and TGF-a levels were higher than those in control group(P＜0.05).In nephropathy group,Hb was positively correlated with eGFR(P＜0.05),and negatively correlated with Scr,BUN,TGF-β1 and TGF-α(P＜0.05).MMP-7 was negatively correlated with eGFR(P＜0.05),and positively correlated with Scr,BUN,TGF-β1 and TGF-α(P＜0.05).The renal cumulative survival rate in the low Hb level group was lower than that in the high Hb level group(P＜0.05),and that in the high MMP-7 level group was lower than that in the low MMP-7 level group(P＜0.05).Multivariate COX regression analysis showed that TGF-β1,TGF-α and MMP-7 were risk factors for ESRD in patients with diabetic nephropathy(P＜0.05),and Hb and eGFR were protective factors for ESRD in patients with diabetic nephropathy(P＜0.05).Conclusion The level of Hb and serum MMP-7 in diabetic nephropathy patients is decreased,and is related to the occurrence of renal function decline,RIF and ESRD.
NETL
NSTL
万方数据