血清sCD40L、sICAM-1水平检测对2型糖尿病肾病的诊断价值

Diagnostic value of serum sCD40L and sICAM-1 in type 2 diabetic nephropathy

目的探讨血清可溶性白细胞分化抗原CD40配体(sCD40L)、可溶性细胞间黏附因子-1(sICAM-1)水平检测对2型糖尿病肾病(DN)的诊断价值。方法选取DN患者80例(观察组)和单纯2型糖尿病(T2DM)患者80例(对照组),检测两组空腹血糖、餐后2h血糖、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、sCD40L、sICAM-1水平以及尿白蛋白/肌酐比值(UACR)、肾小球滤过率(eGFR),采用多因素Logistic回归分析DN发生的危险因素,通过受试者工作特征曲线(ROC)分析血清sCD40L、sICAM-1水平对DN的诊断价值。结果观察组TC、TG、LDL-C、sCD40L、sICAM-1、UACR水平较对照组升高,eGFR较对照组降低(P均<0.05)。多因素Logistic回归分析显示,糖尿病病程、TC、sCD40L、sICAM-1、UACR均是DN的独立危险因素(P均<0.05)。ROC分析显示,血清sCD40L、sICAM-1水平单独诊断DN的敏感性和特异性均在0.75以上,二者联合检测诊断DN的敏感性和特异性分别为0.860和0.848,均高于单独检测(P均<0.05)。结论DN患者血清sCD40L、sICAM-1水平明显升高,联合检测T2DM患者血清sCD40L、sICAM-1水平可及时发现并诊断DN。

Objective To investigate the value of detecting serum soluble CD40 ligand(sCD40L)and soluble intracellular adhesion molecule-1(sICAM-1)in diagnosis of type 2 diabetic nephropathy(DN).Methods Eighty patients with DN(observation group)and 80 patients with simple type 2 diabetes mellitus(control group)were selected.Fasting blood glucose,2 h postprandial blood glucose,serum total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),sCD40L,sICAM-1,urinary microalbumin excretion rate(UACR),and glomerular filtration rate(eGFR)were measured.Multivariate logistic regression was used to analyze the risk factors of DN.The diagnostic value of serum sCD40L and sICAM-1 levels for DN was analyzed by ROC.Results The levels of TC,TG,LDL-C,sCD40L,sICAM-1,and UACR in the observation group were higher than those in the control group,and eGFR was lower than that in the control group(all P<0.05).Multivariate logistic regression analysis showed that the duration of diabetes,TC,sCD40L,sICAM-1 and UACR were independent risk factors for DN(all P<0.05).ROC analysis showed that the sensitivity and specificity of serum sCD40L and sICAM-1 for the diagnosis of DN were above 0.75.The sensitivity and specificity of combined detection of sCD40L and sICAM-1 levels for the diagnosis of DN were 0.860 and 0.848,respectively,which were higher than those of the single detection(all P<0.05).Conclusion Serum levels of sCD40L and sICAM-1 in DN patients increase significantly,and the combined detection of serum sCD40L and sICAM-1 levels in patients with type 2 diabetes mellitus can promptly detect and diagnose DN.