血清可溶性白细胞分化抗原CD40配体和可溶性细胞间黏附因子-1诊断早期糖尿病肾病的价值
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摘要
目的探讨血清可溶性白细胞分化抗原CD40配体(soluble CD40ligand,sCD40L)、可溶性细胞间黏附因子-1(soluble intercellular adhesion molecular-1,sICAM-1)在糖尿病肾病早期诊断中的价值。方法 2型糖尿病患者236例,依据尿微量白蛋白排泄率(urinary albumin excretion rate,UACR)分为单纯糖尿病组(UACR<30mg/24h)121例,早期DN组(UACR 30～300mg/24h)78例,DN组(UACR>300mg/24h)37例,同期体检健康者60例为对照组。检测4组血清sCD40L、sICAM-1水平;Pearson相关法分析血清sCD40L、sICAM-1水平与血生化指标的相关性;ROC曲线分析血清sCD40L、sICAM-1诊断早期DN的效能。结果DN组、早期DN组、单纯糖尿病组、对照组血清sCD40L[(1 241.61±216.39)、(905.36±162.38)、(615.23±114.62)、(498.35±99.28)μg/L]、sICAM-1((9.98±2.14)、(7.69±1.82)、(5.56±1.59)、(3.05±1.02)μg/L)逐渐降低(P<0.05);Pearson相关分析结果显示,2型糖尿病患者血清sCD40L、sICAM-1水平与糖化血红蛋白(r=0.130,P=0.047;r=0.133,P=0.041)、三酰甘油(r=0.193,P=0.003;r=0.182,P=0.008)、低密度脂蛋白胆固醇(r=0.211,P=0.001;r=0.191,P=0.003)、UACR(r=0.743,P<0.001;r=0.572,P<0.001)呈正相关,与估算肾小球滤过率(r=-0.709,P<0.001;r=-0.536,P<0.001)呈负相关;ROC曲线分析结果显示,血清sCD40L以815.74μg/L为最佳截断值,诊断早期DN的AUC为0.907(95%CI:0.863～0.954,P<0.001),灵敏度为78.2%,特异度为96.7%;血清sICAM-1以6.23μg/L为最佳截断值,诊断早期DN的AUC为0.770(95%CI:0.704～0.836,P<0.001),灵敏度为76.9%,特异度为65.3%;二者联合诊断早期DN的AUC为0.913(95%CI:0.872～0.955,P<0.001),灵敏度为84.6%,特异度为85.1%。结论 2型糖尿病患者血清sCD40L和sICAM-1水平明显升高,且增高水平与病情严重程度有关,血清SCD40L和sICAM-1可作为早期DN诊断的分子标志物。
Objective To investigate the value of serum levels of soluble CD40 ligand(sCD40 L)and soluble intercellular adhesion molecular-1(sICAM-1)to the early diagnosis of diabetic nephropathy(DN).Methods According to urinary albumin excretion rate(UACR),236 patients with type 2 diabetes mellitus were divided into diabetic group(UACR<30 mg/24 h,n=121),early DN group(UACR 30-300 mg/24 h,n=78)and DN group(UACR>300 mg/24 h,n=37),and another 60 healthy volunteers were as controls(control group).The serum sCD40 Land sICAM-1 levels were detected.Pearson correlation was used to analyze the correlation of serum sCD40 Land sICAM-1 levels with biochemical markers.ROC curve was drawn to analyze the efficacies of serum sCD40 Land sICAM-1 on the early diagnosis of DN.Results The serum levels of sCD40 L((1 241.61±216.39),(905.36±162.38),(615.23±114.62),(498.35±99.28)μg/L)and sICAM-1((9.98±2.14),(7.69±1.82),(5.56±1.59),(3.05±1.02)μg/L)decreased gradually in DN group,early DN group,diabetic group and control group(P<0.05).Pearson correlation analysis showed that the serum levels of sCD40 Land sICAM-1 in patients with type 2 diabetes mellitus were positively correlated with glycosylated hemoglobin(r=0.130,P=0.047;r=0.133,P=0.041)and triacylglycerol(r=0.193,P=0.003;r=0.182,P=0.008),low-density lipoprotein cholesterol(r=0.211,P=0.001;r=0.191,P=0.003)and UACR(r=0.743,P<0.001;r=0.572,P<0.001),and were negatively correlated with estimated glomerular filtration rate(r=-0.709,P<0.001;r=-0.536,P<0.001).ROC curve analysis showed that when the optimal cut-offvalue of serum sCD40 Lwas815.74μg/L,the AUCfor the early diagnosis of DN was 0.907(95%CI:0.863-0.954,P<0.001),the sensitivity was78.2% and the specificity was 96.7%;when the optimal cut-off of serum sICAM-1 was 6.23μg/L,the AUCfor the early diagnosis of DN was 0.770(95%CI:0.704-0.836,P<0.001),the sensitivity was 76.9% and specificity was65.3%;AUCof the joint detection of sCD40 Land sICAM-1 for the diagnosis of early DN was 0.913(95%CI:0.872-0.955,P<0.001),the sensitivity was 84.6% and the specificity was 85.1%.Conclusion The obvious elevated serum levels of sCD40 Land sICAM-1 in patients with type 2 diabetes mellitus are correlated with the severity of the disease,and might be used as the biomarkers for the early diagnosis of DN.
Objective To investigate the value of serum levels of soluble CD40 ligand(sCD40 L)and soluble intercellular adhesion molecular-1(sICAM-1)to the early diagnosis of diabetic nephropathy(DN).Methods According to urinary albumin excretion rate(UACR),236 patients with type 2 diabetes mellitus were divided into diabetic group(UACR<30 mg/24 h,n=121),early DN group(UACR 30-300 mg/24 h,n=78)and DN group(UACR>300 mg/24 h,n=37),and another 60 healthy volunteers were as controls(control group).The serum sCD40 Land sICAM-1 levels were detected.Pearson correlation was used to analyze the correlation of serum sCD40 Land sICAM-1 levels with biochemical markers.ROC curve was drawn to analyze the efficacies of serum sCD40 Land sICAM-1 on the early diagnosis of DN.Results The serum levels of sCD40 L((1 241.61±216.39),(905.36±162.38),(615.23±114.62),(498.35±99.28)μg/L)and sICAM-1((9.98±2.14),(7.69±1.82),(5.56±1.59),(3.05±1.02)μg/L)decreased gradually in DN group,early DN group,diabetic group and control group(P<0.05).Pearson correlation analysis showed that the serum levels of sCD40 Land sICAM-1 in patients with type 2 diabetes mellitus were positively correlated with glycosylated hemoglobin(r=0.130,P=0.047;r=0.133,P=0.041)and triacylglycerol(r=0.193,P=0.003;r=0.182,P=0.008),low-density lipoprotein cholesterol(r=0.211,P=0.001;r=0.191,P=0.003)and UACR(r=0.743,P<0.001;r=0.572,P<0.001),and were negatively correlated with estimated glomerular filtration rate(r=-0.709,P<0.001;r=-0.536,P<0.001).ROC curve analysis showed that when the optimal cut-offvalue of serum sCD40 Lwas815.74μg/L,the AUCfor the early diagnosis of DN was 0.907(95%CI:0.863-0.954,P<0.001),the sensitivity was78.2% and the specificity was 96.7%;when the optimal cut-off of serum sICAM-1 was 6.23μg/L,the AUCfor the early diagnosis of DN was 0.770(95%CI:0.704-0.836,P<0.001),the sensitivity was 76.9% and specificity was65.3%;AUCof the joint detection of sCD40 Land sICAM-1 for the diagnosis of early DN was 0.913(95%CI:0.872-0.955,P<0.001),the sensitivity was 84.6% and the specificity was 85.1%.Conclusion The obvious elevated serum levels of sCD40 Land sICAM-1 in patients with type 2 diabetes mellitus are correlated with the severity of the disease,and might be used as the biomarkers for the early diagnosis of DN.
引文
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[12]崔巍,贾秋蕾,胡元会,等.血小板微粒膜表面功能蛋白与不稳定型心绞痛相关性[J].中华实用诊断与治疗杂志,2017,31(6):550-553.
[13]王玲,田野,闫红霞,等.冠心病患者发生室性心律失常时血清CD40配体和肿瘤坏死因子-α及白细胞介素-6水平变化及意义[J].中华实用诊断与治疗杂志,2015,29(4):393-395.
[14] FATHOLLAHI A,MASSOUD A,AMIRZARGAR A A,et al.sICAM-1,sVCAM-1 and sE-selectin levels in type 1diabetes[J].Fetal Pediatr Pathol,2018,37(1):69-73.
[15]董霞,韩睿.血清生物标志物对糖尿病肾病早期诊治的临床价值[J].医学综述,2016,22(10):1945-1948.
[16] WANG Y,LI Y M,ZHANG S,et al.Adipokine zinc-alpha-2-glycoprotein as a novel urinary biomarker presents earlier than microalbuminuria in diabetic nephropathy[J].J Int Med Res,2016,44(2):278-286.
[2]郑颖,朱晗玉,蔡广研,等.普罗布考改善糖尿病肾病患者颈动脉内中膜厚度效果观察[J].中华实用诊断与治疗杂志,2017,31(11):1115-1117.
[3]张晶露,邱琳,雒晓春.糖尿病肾病发病机制研究进展[J].医学综述,2017,23(8):1623-1627.
[4]盛文芳,洪斌.不同剂量氯吡格雷对ACS患者PCI术后炎症因子的影响[J].临床和实验医学杂志,2015,14(24):2049-2051.
[5]何荣新,叶陈毅,木明江·依沙克严,等.可溶性细胞间黏附分子-1及皮肤温度对全膝关节置换术后假体周围感染的诊断价值[J].中华骨科杂志,2017,37(7):401-407.
[6]杨敏,于菁,马小羽,等.初诊2型糖尿病患者不同尿白蛋白阶段血清β-trophin、脂联素及白细胞介素1β水平的相关性研究[J].中华内分泌代谢杂志,2017,33(2):116-119.
[7]朱晗玉.糖尿病肾病诊断及预后生物学标志物的研究现状及展望[J].中华实用诊断与治疗杂志,2018,32(1):1-4.
[8]李卉.TRF,Cys-C,RBP和Hcy联合检测对糖尿病肾病的早期诊断价值[J].北华大学学报(自然科学版),2017,18(2):224-227.
[9] KIM S S,KIM J H,KIM I J.Current challenges in diabetic nephropathy:early diagnosis and ways to improve outcomes[J].Endocrinol Metab(Seoul),2016,31(2):245-253.
[10] MIRHOSEINI M,SALEH N,MOMENI A,et al.A study on the association of diabetic dermopathy with nephropathy and retinopathy in patients with type 2diabetes mellitus[J].J Nephropathol,2016,5(4):139-143.
[11] ZHENG T,LIU Y,QIN S,et al.Increased plasma dipeptidyl peptidase-4activities are associated with high prevalence of diabetic nephropathy in Chinese patients with newly diagnosed type 2diabetes:a cross-sectional study[J].Diab Vasc Dis Res,2016,13(2):127-136.
[12]崔巍,贾秋蕾,胡元会,等.血小板微粒膜表面功能蛋白与不稳定型心绞痛相关性[J].中华实用诊断与治疗杂志,2017,31(6):550-553.
[13]王玲,田野,闫红霞,等.冠心病患者发生室性心律失常时血清CD40配体和肿瘤坏死因子-α及白细胞介素-6水平变化及意义[J].中华实用诊断与治疗杂志,2015,29(4):393-395.
[14] FATHOLLAHI A,MASSOUD A,AMIRZARGAR A A,et al.sICAM-1,sVCAM-1 and sE-selectin levels in type 1diabetes[J].Fetal Pediatr Pathol,2018,37(1):69-73.
[15]董霞,韩睿.血清生物标志物对糖尿病肾病早期诊治的临床价值[J].医学综述,2016,22(10):1945-1948.
[16] WANG Y,LI Y M,ZHANG S,et al.Adipokine zinc-alpha-2-glycoprotein as a novel urinary biomarker presents earlier than microalbuminuria in diabetic nephropathy[J].J Int Med Res,2016,44(2):278-286.