YKL-40在2型糖尿病肾病患者早期诊断中的临床价值

Clinical Value of YKL-40 in the Early Diagnosis of Type 2 Diabetic Nephropathy

目的:探讨血清几丁质酶3样蛋白1(YKL-40)与2型糖尿病(T2DM)早期肾病患者病情变化的关系,为临床生物标志物的研究和应用提供科学依据。方法:收集2013年1月至2017年1月145例在我院肾内科接受治疗的T2DM肾病患者作为试验组,同时选择110例T2DM尿蛋白指标无异常的患者作为对照组。首次通过ROC曲线分析YKL-40对早期糖尿病肾病(DN)诊断的价值,并用logistic回归分析早期DN患者的影响因素。结果:早期DN患者组的病程、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、YKL-40与对照组均有统计学差异(P<0.05);YKL-40与蛋白尿、视网膜病变、HbA1c、患者年龄呈正相关(P<0.05);YKL-40对DN诊断的浓度-时间曲线下面积(AUC)为0.815(95%CI:0.760~0.870),灵敏度为90.1%,特异度为78.2%,YKL-40临界值为48.1 ng/mL;HbA1c(OR=1.124)、视网膜病变(OR=1.118)和YKL-40(OR=1.075)与T2DM患者早期DN发生存在相关性(P<0.05)。结论:YKL-40在T2DM患者早期DN发生和发展中存在必然的变化,但是其准确性(尤其是临界值的确定)尚需更多的临床研究来作依据。

Objective:To explore the relevance between serum YKL-40 and the development of early stage nephropathy in patients with type 2 diabetes mellitus(T2DM),and to provide scientific basis for the research and application of related clinical biomarkers.Methods:From January 2013 to January 2017,145 patients of T2DM with abnormal urinary protein were included in the experimental group,and 110 patients of T2DM without abnormal urinary protein were included in the control group.The value of YKL-40 in early diagnosis of diabetic nephropathy(DN)was analyzed by ROC curve for the first time,and the influencing factors for early DN patients were analyzed by logistic regression.Results:There were significant differences between the early DN group and control group(P<0.05)considering the course of disease,FBG,HbA 1c and YKL-40.YKL-40 was positively related with proteinuria,retinopathy,HbA 1c,and patient age(P<0.05);The AUC value of the curve describing YKL-40 for DN diagnosis was 0.815(95%CI:0.760~0.870),with sensitivity of 90.1%and specificity of 78.2%.The critical value for YKL-40 is 48.1 ng/ml.HbA1c(OR=1.124),retina Pathological changes(OR=1.118)and YKL-40(OR=1.075)were correlated with early DN in T2DM(P<0.05).Conclusion:YKL-40 is significantly related to the occurrence and development of early DN in T2DM patients,but its accuracy(especially the determination of critical value)needs further clinical research.