可溶性ST2在糖尿病肾脏疾病患者中的临床价值

Clinical value of sST2 in diabetic nephropathy

目的探讨可溶性生长刺激表达基因2蛋白(soluble growth stimulation expressed gene 2,sST2)在糖尿病肾脏疾病(Diabetic Kidney Disease,DKD)及DKD晚期合并心脏功能损伤患者中的临床价值。方法选取皖南医学院弋矶山医院2019年9月至12月和2020年5月至6月间收治的143例2型糖尿病有无并发肾脏疾病及不同阶段的患者,分为糖尿病组(n=38)、DKD早期组(n=32)、DKD中期组(n=35)和DKD晚期合并心脏功能损伤组(n=38)。采用磁微粒化学发光法检测血清sST2的浓度。利用受试者工作特征(Receiver Operating characteristic Curve,ROC)曲线分析血清sST2诊断DKD的价值。结果四组患者血清sST2的检测结果之间存在差异(Z=22.842,P<0.05),DKD晚期合并心脏功能损伤患者的sST2水平显著高于糖尿病组患者和DKD早、中期组患者(P<0.05)。心功能分级糖尿病患者血清sST2的检测结果之间存在差异(F=5.46,P<0.05),心功能Ⅳ级患者的sST2水平显著高于心功能Ⅰ、Ⅱ、Ⅲ级患者(P<0.05),但Ⅰ、Ⅱ、Ⅲ级患者之间两两比较无差异(P>0.05)。ROC曲线分析显示,sST2与Cr联合诊断DKD晚期合并心脏功能损伤患者的曲线下面积(AUC)分别为0.741和0.792,截断值分别为10.77 ng/mL和227.2μmol/L。两者联合检测的AUC为0.836,高于sST2与Cr单独诊断DKD晚期合并心脏功能损伤的患者。结论sST2在诊断DKD晚期合并心脏功能损伤患者中具有一定的潜在价值,有望成为判断DKD患者合并心脏功能损伤的血清标志物。

Objective To explore the clinical value of soluble growth stimulation expressed gene 2(sST2)in diabetic kidney disease(DKD)and diabetic uremic patients complicated with cardiac dysfunction.Methods 143 patients with type 2 diabetes mellitus complicated with kidney disease and different stages in the Yijishan Hospital of Wannan Medical College from September to December 2019 and from May to June 2020 were divided into four groups:diabetes mellitus(n=38),early stage of DKD(n=32),middle stage of DKD(n=35),and late stage of DKD complicated with cardiac dysfunction(n=38).The concentration of sST2 in serum was detected by magnetic particle chemiluminescence.Receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of serum sST2 in DKD.Results There was significant difference between the four groups(Z=22.842,P<0.05).The level of serum sST2 in patients with late stage of DKD complicated with cardiac dysfunction was significantly higher than that in patients with diabetes mellitus and early and middle stage of DKD(P<0.05).The difference between the four groups with cardiac functional grading was significant(F=5.46,P<0.05).The level of serum ST2 in patients with grade IV was significantly higher than that in patients with grade Ⅰ,Ⅱ and Ⅲ(P<0.05),but there was no significant difference between patients with grade Ⅰ,Ⅱ and Ⅲ(P>0.05).ROC curve analysis showed that the area under the curve(AUC)of sST2 combined with Cr in the diagnosis of late DKD patients with cardiac dysfunction was 0.741 and 0.792,and the cut-off values were 10.77 ng/mL and 227.2μmol/L,respectively.The AUC of combined detection was 0.836,which was higher than that of sST2 and Cr alone in the diagnosis of late DKD patients with cardiac dysfunction.Conclusion sST2 has potential value in the diagnosis of late stage of DKD with cardiac dysfunction patients,and is expected to become a serum marker to judge the disease stratification of DKD patients.