血清C1q、Th17/CD4^+T、sICAM-1联合检测在评估糖尿病肾病预后中的价值

Value of combined detection of serum levels of C1q,Th17/CD4^+T and sICAM-1 in evaluating prognosis of patients with diabetic nephropathy

目的探讨血清补体C1q、Th17细胞占CD4^+T细胞比率(Th17/CD4^+T)及可溶性细胞间黏附分子-1(sICAM-1)表达水平在糖尿病肾病(DN)患者预后评估中的价值。方法选取2014年1月至2017年12月该院肾内科接受治疗的确诊为DN的100例患者作为研究对象,根据24h尿蛋白量和(或)尿蛋白排泄率(UAER)将其分为尿蛋白量正常组(NAU组)、微量蛋白尿组(MAU组)和大量蛋白尿组(MAAU组),检测并比较各组血清C1q、Th17/CD4^+T、sICAM-1表达水平;将MAU组患者分为血清C1q(+)组、C1q(-)组,Th17/CD4^+T(+)组、Th17/CD4^+T(-)组和sICAM-1(+)组、sICAM-1(-)组,比较各亚组的相关临床参数。采用Pearson分析血清C1q、Th17/CD4^+T、sICAM-1表达水平与尿蛋白、估算肾小球滤过率(eGFR)的相关性,探讨DN患者有无微量蛋白尿出现和早期肾功能降低的独立危险因素。结果(1)MAAU组、MAU组和NAU组血清C1q、Th17/CD4^+T、sICAM-1表达水平比较差异有统计学意义(P<0.05)。(2)C1q(+)组、Th17/CD4^+T(+)组和sICAM-1(+)组的糖尿病病程、高血压病程、血压、三酰甘油、尿蛋白定量、肾小球滤过率、血清肌酐等与C1q(-)组、Th17/CD4^+T(-)组和sICAM-1(-)组比较差异有统计学意义(P<0.05)。(3)NAU组和MAU组患者的血清C1q水平与UAER呈负相关(r=-0.378,P<0.05),Th17/CD4^+T和sICAM-1与UAER呈正相关(r1=0.406,r2=0.385,P<0.05);血清C1q降低、Th17/CD4^+T及sICAM-1升高均是影响蛋白尿发生和轻度肾功能降低的独立因素(P<0.05)。(4)以24h尿蛋白≥30mg作为DN的诊断金标准,血清C1q、Th17/CD4^+T、sICAM-1表达水平诊断DN的受试者工作特征曲线下面积分别为0.663、0.659和0.703,三者联合检测的曲线下面积为0.931。结论 2型糖尿病患者血清C1q、Th17/CD4^+T、sICAM-1表达水平变化与出现微量蛋白尿水和早期肾功能降低独立相关。

Objective To investigate the value of serum complement C1 q(C1 q),Th17 cells in CD4^+T cell ratio(Th17/CD4^+T)and soluble intercellular adhesion molecule-1(sICAM-1)expression in the prognosis of diabetic nephropathy.Methods A total of 100 patients diagnosed with DN who received treatment in the Renal medicine department of a hospital from January 2014 to December 2017 were selected as research objects.100 DN patients were divided into the NAU group,MAU group and MAAU group,the levels of serum C1 q,Th17/CD4^+T and sICAM-1 were compared.Group NAU and group MAU were divided into C1 q(+)group,C1 q(-)group,Th17/CD4^+T(+)group,Th17/CD4^+T(-)group and sICAM-1(+)group,sICAM-1(-)group.The related clinical parameters of the patients were compared.Pearson correlation analysis was used to analyze the correlation between serum levels of C1 q,Th17/CD4^+T,sICAM-1 and urinary protein and estimated glomerular filtration rate(eGFR).The independent risk factors for the presence of microalbuminuria and the decrease of early renal function in DN patients were analyzed.Results(1)There was a significant difference in the levels of C1 q,Th17/CD4^+T and sICAM-1 in MAAU,MAU and NAU groups(P<0.05).(2)There were significant differences between the C1 q(+)group and the C1 q(-)group,the Th17/CD4^+T(-)group and the Th17/CD4^+T(+)group,the sICAM-1(-)group and the sICAM-1(+)group in the diabetes course,the course of hypertension,the blood pressure,the three acylglycerol,the quantitative urine protein,the estimated glomerular filtration rate of the retinopathy,the serum creatinine(P<0.05).(3)The serum C1 q level of patients in group NAU and MAU was negatively correlated with UAER(r=-0.378,P<0.05),and Th17/CD4^+T and sICAM-1 were positively correlated with UAER(r1=0.406,r2=0.385,P<0.05).Decreased serum C1 q,elevated Th17/CD4^+T and sICAM-1 were independent factors affecting albuminuria and mild renal function(P<0.05).(4)The area under ROC curve(AUC)of serum C1 q,Th17/CD4^+T cells and sICAM-1 levels for diagnosis of DN was 0.663,0.659 and 0.703,respectively,the combined detection of AUC was 0.931.Conclusion The changes in the expression of C1 q,Th17/CD4^+T and sICAM-1 in patients with type 2 diabetes are independent of the occurrence of microalbuminuria and the decrease of early renal function.