血清β_(2)微球蛋白、胱抑素C和甘油三酯间交互作用对2型糖尿病肾脏疾病预测价值

Predictive value of the interaction among β_(2) microglobulin,cystatin C and triacylglycerol on type 2 diabetic kidney disease

目的研究2型糖尿病肾脏疾病(diabetic kidney disease,DKD)的独立危险因素,探讨因子间是否具有交互作用及联合因子检测对DKD患病的预测价值。方法选取2019年6~12月桂林医学院附属医院收治的135例DKD患者为糖肾组,选取同期126例非糖尿病肾病患者为对照组,比较两组基本资料及生化指标,应用logistic回归分析筛选出独立危险因素,进行相乘交互作用分析,绘制并比较各因素及联合因子的ROC曲线。结果糖肾组患者病程、体质量指数(body mass index,BMI)、尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,SCr)、β_(2)微球蛋白、胱抑素C(cystatin C,CysC)、甘油三酯(triacylglycerol,TG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)及视网膜病变患病率均明显高于对照组,差异有统计学意义(P<0.05);肾小球滤过率(glomerular filtration rate,GFR)显著低于对照组,差异有统计学意义(P<0.05);多因素logistic回归分析表明,血清TG、β_(2)微球蛋白、CysC是DKD的独立危险因素(P<0.01);β_(2)微球蛋白和CysC、CysC和TG之间均具有相乘交互作用(P<0.05);联合因子ROC曲线下面积(0.82,P<0.01)均大于单个因素。结论血清TG、β_(2)微球蛋白、CysC为DKD的独立危险因素,且具有交互作用,联合检测对DKD具有较好的预测价值,有利于临床上早期识别及干预。

Objective To study independent risk factors of type 2 diabetic kidney disease(DKD),explore whether there is interaction between factors,and predictive values of the combined factor detection for the DKD.Methods A total of 135 DKD patients hospitalized in Affiliated Hospital of Guilin Medical University from June to December 2019 were chosen as the diabetic nephropathy group,and 126 nondiabetic kidney disease patients with matching age and sex ratios at the same period were selected as the control group.The basic conditions and biochemical indexes of the two groups were compared,using the Logistic regression analysis to screen out independent risk factors,and analysis the multiplication interaction,drawing and comparing the ROC curves of each factors and their combined factor.Results Levels of course of disease,body mass index(BMI),blood urea nitrogen(BUN),serum creatinine(SCr),β_(2)microglobulin,cystatin C(CysC),triacylglycerol(TG),glycosylated hemoglobin(HbA1c),and the prevalences of retinopathy were significantly higher in the diabetic nephropathy group than in the control group(P<0.05),and the glomerular filtration rate(GFR)was significantly lower(P<0.05).Multivariate Logistic regression analysis showed that serum TG,beta 2 microglobulin and CysC were independent risk factors of DKD(P<0.01).The multiplication interaction existed between beta 2 microglobulin and CysC,as well as CysC and TG(P<0.05).The areas under the ROC curves of the combined factor(0.82,P<0.01)was greater than single factor.Conclusions Serum TG,beta 2 microglobulin and CysC are independent risk factors of DKD,the factors have interactions.The combined detection has a good predictive value for DKD,which is helpful for early identification and intervention in clinic.