2型糖尿病肾病患者血清sTNFR-1及KIM-1水平及其诊断价值研究

Serum Soluble TNFR-1and KIM-1Level in Diabetic Kidney Disease Patients with Type 2 Diabetes Mellitus and Their Diagnostic Value

目的探讨2型糖尿病肾病患者血清可溶性肿瘤坏死因子受体1(soluble tumor necrosis factor receptor-1,sTNFR-1)及肾损伤分子-1(kidney injury molecule-1,KIM-1)水平变化及其诊断价值。方法回顾性分析2012年5月—2016年5月云南省老年病医院及云南省第一人民医院就诊的2型糖尿病患者112例,根据白蛋白尿及透析情况分为:正常组(A1期组) 37例,中度增加组(A2期组) 35例,重度增加组(A3期组)25例及透析组15例。检测各组患者血清sTNFR-1及KIM-1水平,分析sTNFR-1及KIM-1与其他临床指标的相关性;并进一步绘制受试者工作特征(receiver operating characteristic curve,ROC)曲线分析sTNFR-1联合KIM-1检测对于糖尿病肾损伤的诊断效能。结果血清sTNFR-1及KIM-1水平透析组> A3期组> A2期组> A1期组,每两组间比较差异均有统计学意义(P<0.05)。所有患者血清sTNFR-1水平与糖尿病病程、平均动脉压(MAP)、尿微量白蛋白定量(Um Alb)、血肌酐(Cr)、尿白蛋白肌酐比(ACR)呈显著正相关(r=0.341,P<0.001; r=0.447,P<0.001; r=0.569,P<0.001; r=0.585,P<0.001; r=0.537,P<0.001),与肾小球滤过率估值(e GFR)呈显著负相关(r=-0.594,P<0.001);血清KIM-1水平与糖尿病病程、MAP、Um Alb、ACR、血Cr亦呈显著正相关(r=0.403,P<0.001; r=0.527,P<0.001; r=0.733,P<0.001; r=0.702,P<0.001; r=0.733,P<0.001),与e GFR呈显著负相关(r=-0.757,P<0.001)。血清sTNFR-1联合KIM-1检测对于糖尿病肾损伤的诊断效能较单独检测高,曲线下面积为0.857 (95%CI:0.787,0.927,P<0.001),诊断特异度为83.8%,灵敏度为84.5%,阳性预测值为0.902,阴性预测值为0.826。结论 2型糖尿病肾病患者血清sTNFR-1及KIM-1水平升高,sTNFR-1联合KIM-1检测对于糖尿病肾损伤的诊断效能较高。

Objective To investigate changes of the levels of serum soluble tumor necrosis factor receptor-1(sTNFR-1)and kidney injury molecule-1(KIM-1)in diabetic kidney disease(DKD)patients with type 2 diabetes mellitus(T2DM)and their diagnostic value.Methods Clinical data of 112 patients with T2DM who were treated in Yunnan Provincial Geriatric Hospital and the First People's Hospital of Yunnan Province from May 2012 to May 2016 were retrospectively analyzed.They were divided into normal increase group(stage A1 group,n=37),moderate increase group(stage A2 group,n=35)and severe increase group(stage A3 group,n=25)and dialysis group(n=15)according to the albuminuria and dialysis situation.The serum sTNFR-1 and KIM-1 levels were tested in all groups.ROC curve was used to analyze the clinical value of sTNFR-1 and KIM-1 for the diagnosis of renal function impairment in DKD.Results Serum sTNFR-1 and KIM-1 levels were the highest in dialysis group,followed by stage A3 group,stage A2 group and stage A1 group(P<0.05).In all patients,sTNFR-1 was positively correlated with DM duration,MAP,UmAlb,serum Cr and ACR(r=0.341,P<0.001;r=0.447,P<0.001;r=0.569,P<0.001;r=0.585,P<0.001;r=0.537,P<0.001),and negatively correlated with eGFR(r=-0.594,P<0.001).Serum KIM-1 was positively correlated with DM duration,MAP,UmAlb,ACR and serum Cr(r=0.403,P<0.001;r=0.527,P<0.001;r=0.733,P<0.001,r=0.702,P<0.001;r=0.733,P<0.001),and negatively correlated with eGFR(r=-0.757,P<0.001).The diagnostic efficacy of sTNFR-1 combined with KIM-1 for detection of diabetic renal injury was higher than that of each test alone,and the AUC was 0.857(95%CI:0.787,0.927,P<0.001).The diagnostic specificity and sensitivity,were 83.8%and 84.5%respectively,and the positive and negative predictive values were 0.902 and 0.826 respectively.