糖尿病肾脏疾病患者血清脑啡肽酶及几丁质酶1水平变化及影响因素分析

Changes of serum neprilysin and chitotriosidase levels in patients with diabetic kidney disease and analysis of the influencing factors

目的分析DKD患者血清脑啡肽酶(NEP)及几丁质酶1(CHIT1)水平变化及影响因素。方法选取2017年5月至2019年3月于保定市第一中心医院内分泌科就诊的T2DM患者167例,按照不同UACR水平分为正常白蛋白尿组(UACR<30 mg/g)54例、微量白蛋白尿组(30≤UACR<300 mg/g)62例和大量白蛋白尿组(UACR≥300 mg/g)51例,另选取同期健康体检人群50名为正常对照(NC)组。ELISA法测定血清NEP、CHIT1水平,Spearman相关分析血清NEP、CHIT1水平与各指标间的相关性,多元逐步回归分析血清NEP、CHIT1的影响因素。结果各组血清NEP、CHIT1水平随UACR升高依次升高[(102.39±7.51)vs(111.14±13.97)vs(118.11±16.62)vs(126.82±19.31)U/L,(0.79±0.21)vs(1.28±0.18)vs(1.71±0.31)vs(2.30±0.29)ng/ml,P<0.05]。Spearman相关分析显示,血清NEP水平与年龄、SBP、BMI、血肌酐(Scr)、BUN、FPG、HbA1c、UAlb、UAER、UACR、24 hUAlb、CHIT1呈正相关(P<0.01),与AST、血清白蛋白(ALB)呈负相关(P<0.05);血清CHIT1水平与SBP、BMI、TG、Scr、BUN、eGFR、FPG、HbA1c、UAlb、UAER、UACR、24 hUAlb、NEP呈正相关(P<0.01),与AST、ALB呈负相关(P<0.05或P<0.01)。多元逐步回归分析结果显示,BUN、UAlb、CHIT1是血清NEP的影响因素;Scr、ALB、eGFR、UACR、NEP是血清CHIT1的影响因素。结论DKD患者血清NEP、CHIT1水平均升高,与严重程度相关,提示NEP、CHIT1参与DKD的发生发展。

Objective To investigate the changes of serum Neprilysin(NEP)and Chitotriosidase(CHIT1)levels in patients with diabetic kidney disease(DKD)and the influencing factors.Methods A total of 167 patients with type 2 diabetes mellitus(T2 DM)admitted to the Endocrinology Department of Baoding First Central Hospital from May 2017 to March 2019 were selected in this study.All the patients were divided into three groups according to their UACR results:normal albuminuria group(UACR<30 mg/g,n=54),microalbuminuria group(30<UACR<300 mg/g,n=62),and macro albuminuria group(UACR≥300 mg/g,n=51).Healthy subjects during the same period were selected as the normal controls(NC group,n=50).Serum NEP and CHIT1 were determined by ELISA.Spearman correlation analysis was used to evaluate the relationship between serum NEP,CHIT1 levels and the indicators.Multiple stepwise regression analysis was used to find influencing factors for serum NEP and CHIT1.Results Serum NEP and CHIT1 levels were increased successively in the four groups[(102.39±7.51)vs(111.14±13.97)vs(118.11±16.62)vs(126.82±19.31)U/L,P<0.05],[(0.79±0.21)vs(1.28±0.21)vs(1.71±0.21)vs(2.30±0.21)ng/ml,P<0.05].Spearman correlation analysis showed that serum NEP concentration was positively correlated with age,SBP,BMI,Scr,BUN,FPG,Hb A1 c,UAlb,UAER,UACR,24 h UAlb and CHIT1(P<0.01)and negatively correlated with AST and ALB(P<0.05).Serum CHIT1 was positively correlated with SBP,BMI,TG,Scr,BUN,e GFR,FPG,Hb A1 c,UACR,UAlb,UAER,24 h UAlb and NEP(P<0.01),while negatively correlated with AST and ALB(P<0.05 or P<0.01).Multiple stepwise regression analysis showed that BUN,UAlb and CHIT1 were the influencing factors for serum NEP,while Scr,e GFR,ALB,UACR and NEP were the influencing factors for serum CHIT1.Conclusion The serum levels of NEP and CHIT1 were increased in patients with DKD,which was related to the severity of the disease.It suggested that NEP and CHIT1 might be involved in the occurrence and development of DKD.