血清同型半胱氨酸 胱抑素 维生素B6及炎症因子在糖尿病肾脏病中的临床意义

The clinical value of serum homocysteine CysC vitamin B6 and inflammatory cytokines in diabetic kidney disease

目的探讨血清同型半胱氨酸(Hcy)、胱抑素C(Cys-C)、维生素B6(Vit B6)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)与糖尿病肾脏病(DKD)的相关性,分析DKD的相关危险因素。方法收集2015年3月至2016年1月皖北煤电集团总医院肾内科及内分泌科收治的2型糖尿病患者80例,根据24 h尿白蛋白排泄率分为非DKD组(19例)和DKD组(61例)。酶联免疫吸附法统一检测血清IL-6、TNF-α、Vit B6水平。受试者工作特征曲线(ROC)分析Cys-C对DKD的诊断价值,Spearman相关分析检验各指标与DKD患者Cys-C和Hcy的相关性,DKD患者的Hcy和Cys-C相关分析采用多元线性回归分析。结果 Cys-C的ROC曲线下面积为0.77(P<0.05),灵敏度为57.38%,特异度为84.21%,尿酸(SUA)、24 h尿白蛋白与DKD患者的Cys-C水平呈正相关(rs=0.531、0.515,P<0.05),Vit B6、SUA与DKD患者Hcy水平呈正相关(rs=0.342、0.289,P<0.05)。多元线性回归分析显示,SUA、24 h尿白蛋白、Hcy与Cys-C呈正相关性(P<0.05)。结论 Cys-C对DKD有诊断价值,SUA、尿白蛋白、Hcy参与DKD发生发展,Vit B6通过降低Hcy对DKD起到保护作用。

Eighty patients with type 2 diabetes entered the study from March 2015 to Jan 2016 in this hospital.We conducted a case-control study among among 19 non-DKD patients and 61 DKD patients according to their 24 h urinary albumin excretion.Vitamin B6,TNF-α,IL-6 were measured using ELISA.The diagnostic value of Cys-C was evaluated using receiver operating characteristic curve(ROC).Spearman Rank Correlation wasemployedto examine theassociation between Cys-C Hcy and other data.Multivariable linear regression modelswere used to examine the association between Cys-C and Hcy in DKD patients.Results In ROC Curve the area under the curve of Cys-C was 0.77(P<0.05),the sensitivity was 57.38%,and thespecificity was 84.21%.SUA and 24 h proteinuria(r s=0.531,0.515,P<0.05)were positively correlated with Cys-C.Vitamin B6 SUA(r s=0.342,0.289,P<0.05)waspositively correlated with Hcy.Multivariable linear regression showed that SUA Hcy and proteinuria were positively correlated with Cys-C(P<0.05).Conclusion Cys-C has predictive function on diabetic nephropathy.SUA proteinuria and Hcy play a role inthe pathogenesis and progression of diabetic nephropathy.Vitamin B6 has protective effect on DKD.