糖尿病肾病患者血清ACA、IL-6、NGAL水平变化及意义

Changes in levels of serum ACA,IL-6,and NGAL in patients with diabetic kidney disease and the clinical significance

目的探讨糖尿病肾病(DKD)患者血清抗心磷脂抗体(ACA)、白细胞介素6(IL-6)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平及临床意义。方法选取129例DKD患者,在估算肾小球滤过率(e GFR)> 60m L/(min·1. 73 m2)时,根据尿清蛋白肌酐比值(ACR)将其分为微量清蛋白尿组(A组)34例和临床蛋白尿组(B组)42例,e GFR≤60 m L/(min·1. 73 m2)为慢性肾衰期组(C组)53例,同时收集50例单纯糖尿病患者为D组。采用酶联免疫吸附法测定各组血清ACA(ACA-IgG、ACA-IgA、ACA-IgM)、IL-6水平,乳胶增强免疫比浊法检测血清NGAL水平,分析各指标的相关性并采用多因素Logistic回归分析DKD的危险因素。结果 A、B、C组ACR、Cys C水平高于D组(P均<0. 05);B、C组e GFR低于A组(P均<0. 05),ACR、Cys C水平高于A组;C组e GFR低于B组(P <0. 05),ACR、Cys C水平高于B组(P均<0. 05)。C组Scr水平高于A、B、D组(P均<0. 05)。A、B、C组血清ACA-IgA、IL-6、NGAL水平高于D组,B、C组高于A组,C组高于B组(P均<0. 05);C组血清ACA-IgG水平高于A、B、D组,A、B组血清ACA-IgM水平高于C、D组(P均<0. 05)。Pearson积矩相关分析,ACA不同分型与e GFR呈负相关(r分别为-0. 392、-0. 287、-0. 331,P分别为0. 037、0. 034、0. 198),与ACR、Cys C呈正相关(r分别为0. 376、0. 456、0. 407;0. 368、0. 398、0. 361,P分别为0. 046、0. 009、0. 042;0. 034、0. 013、0. 071);IL-6与e GFR呈负相关(r=-0. 363,P <0. 05),与ACR、Cys C、Scr呈正相关(r分别为0. 491、0. 467、0. 375,P均<0. 05);NGAL与ACR、Cys C呈正相关(r分别为0. 527、0. 502,P均<0. 05)。e GFR是DKD的保护因素(OR=0. 710,P <0. 05),ACR、Cy-s C、Scr、ACA-IgA、IL-6、NGAL是DKD的独立危险因素(OR分别为1. 103、1. 879、1. 394、2. 938、1. 269、1. 362,P均<0. 05)。结论 DKD患者血清ACR、IL-6、NGAL水平高于单纯糖尿病患者,且随着DKD患者肾损伤病情的加重呈上升趋势,与DKD发病密切相关,早期检测对预测糖尿病患者早期肾损伤有重要价值。

Objective To explore the expression and serum anti-cardiolipin antibodies(ACA),interleukin-6(IL-6)and neutrophil gelatinase-associated lipocalin(NGAL)in patients with diabetic kidney disease(DKD)and its clinical significance.Methods Totally 129 patients with DKD were enrolled.According to the urinary albumin creatinine ratio(ACR),when the estimated glomerular filtration rate(eGFR)was >60 mL/(min·1.73 m 2),they were divided into the micro albuminuria group(group A,n=34)and clinical proteinuria group(group B,n=42);when the estimated glomerular filtration rate(eGFR)was≤60 mL/(min·1.73 m 2),they were taken as the chronic renal failure group(group C,n=53);at the same time,50 patients with simple diabetes were collected as the group D.The serum ACA(ACA-IgG,ACA-IgA,and ACA-IgM)and IL-6 level were determined by enzyme-linked immunosorbent assay.The serum NGAL level was detected by latex-enhanced immunoturbidimetric assay.The correlations between the indexes and the risk factors for DKD were analyzed by Logistic regression analysis.Results The ACR and CysC levels of the groups A,B,and C were significantly higher than those of group D(both P<0.05).The eGFR levels were lower,and the ACR and CysC levels were higher in the groups B and C than in the group A(all P<0.05).The eGFR level was lower and the ACR and CysC levels were higher in the group C than in the group B(all P<0.05),and the Scr level in group C was higher than that in the groups A,B and D(all P<0.05).The levels of serum ACA-IgA,IL-6 and NGAL in the groups A,B,and C were higher than those in the group D,and those in the groups B and C were higher than those in the group A,and the group C was higher than the group B(all P<0.05).The ACA-IgG level in group C was higher than that in the groups A,B,and D,and the ACA-IgM levels in the groups A and B were higher than those in the groups C and D(both P<0.05).Pearson product moment correlation analysis showed that the different types of ACA were negatively correlated with eGFR(r=-0.392,-0.287,-0.331;P=0.037,0.034,and 0.198,respectively),and positively correlated with ACR,CysC(r=0.376,0.456,0.407;0.368,0.398,0.361;P=0.046,0.009,0.042;0.034,0.013,0.071,respectively).IL-6 was negatively correlated with eGFR(r=-363,P<0.05),and positively correlated with ACR,CysC,and Scr(r=0.491,0.467,0.375;all P<0.05).NGAL was positively correlated with ACR and CysC(r=0.527 and 0.502;both P<0.05).The eGFR was the protective factor for DKD(OR=0.710,P<0.05).ACR,CysC,Scr,ACA-IgA,IL-6,and NGAL were independent risk factors for DKD(OR=1.103,1.879,1.394,2.938,1.269,and 1.362;all P<0.05).Conclusions The serum levels of ACR,IL-6,and NGAL in the DKD patients are higher than those in the simple diabetes mellitus patients.With the aggravation of renal injury in DKD patients,the levels of ACR,IL-6,and NGAL increase,which is closely related to the onset of DKD.Early detection of them is of great value in predicting early renal injury in diabetes mellitus patients.