老年糖尿病肾病患者血清SP-D水平表达及其基因多态性与并发肺部感染的相关性研究

Research on the Relationship between Serum SP-D Level,Gene Olymorphism and Pulmonary Infection in Elderly Patients with Diabetic Nephropathy

目的研究老年糖尿病肾病(diabetic nephropathy,DN)患者血清表面活性蛋白D(surfactant protein D,SP-D)水平表达及其基因多态性与并发肺部感染的相关性。方法收集2018年4月~2020年10月咸阳市第一人民医院108例老年DN患者作为研究对象,根据是否伴有肺部感染,将患者分为感染组(n=26)和对照组(n=82)。比较两组患者血清SP-D水平,检测SP-D基因多态性分布。参照肺炎严重指数(pneumonia severity index,PSI),记录26例肺部感染患者严重程度。分析血清SP-D及其基因多态性与肺炎严重程度的关系。结果ELISA结果显示,与对照组血清SP-D(20.02±4.54 ng/L)比较,感染组血清SP-D(24.18±5.39 ng/L)显著升高(t=3.888,P<0.05)。感染组患者SP-D基因型频率分布(TT型4例、CT型7例和CC型15例),与对照组(TT型22例、CT型45例和CC型15例)比较,差异有统计学意义(χ^(2)=15.310,P<0.05)。26例肺部感染中轻度14例、中度8例和重度4例。轻度组、中度组及重度组三组血清SP-D(17.24±3.77 ng/L,23.17±3.82 ng/L及25.29±2.18 ng/L)水平比较,差异有统计学意义(F=11.325,P<0.05)。轻度组(TT型3例、CT型5例和CC型6例)、中度组(TT型1例、CT型2例和CC型5例)及重度组(TT型0例、CT型0例和CC型4例)基因型分布比较,差异有统计学意义(χ^(2)=4.288,P<0.05)。ROC分析显示血清SP-D判断DN并发肺部感染的AUC为0.779(SE=0.056,95%CI=0.669~0.890,P=0.000),敏感度和特异度分别为0.769和0.598。结论血清SP-D有助于判断DN并发肺部感染风险,CC基因型患者较其他患者更易发生肺部感染。

Objective To study the relationship between serum surfactant protein D(SP-D)level,gene polymorphism and pulmonary infection in elderly patients with diabetic nephropathy(DN).Methods The 108 cases elderly patients with DN from April 2018 to October 2020 in the First People’s Hospital of Xianyang City were collected as the research objects.The patients were divided into infection group(n=26)and control group(n=82),which accorded to the presence or absence of pulmonary infection.The two groups of patients with serum SP-D level was compared,the distribution of SP-D gene polymorphism was detected.The severity of 26 patients with pulmonary infection was recorded,which accorded to the pneumonia severity index(PSI).The relationship between serum SP-D and its gene polymorphism and the severity of pneumonia were analyed.Results The results of enzyme-linked immunosorbent assay(ELISA)showed that the serum SP-D of infection group(24.18±5.39 ng/L)were significantly increased,which compared with the control group(20.02±4.54 ng/L)(t=3.888,P<0.05).The frequency distribution of SP-D genotype in infection group(4 cases of TT type,7 cases of CT type and 15 cases of CC type)was significantly different from that of control group(22 cases of TT type,45 cases of CT type and 15 cases of CC type)(χ^(2)=15.310,P<0.05).There were 14 cases of mild,8 cases of moderate and 4 cases of severe in the 26 cases of pulmonary infection.There were significant differences in serum SP-D levels among mild group,moderate group and severe group(17.24±3.77 ng/L,23.17±3.82 ng/L and 25.29±2.18 ng/L)(F=11.325,P<0.05).There were significant differences in genotype distribution between mild group(TT type 3 cases,CT type 5 cases,CC type 6 cases),moderate group(TT type 1 case,CT type 2 cases,CC type 5 cases)and severe group(TT type 0 cases,CT type 0 cases,CC type 4 cases)genotype distribution difference was statistically significant(χ^(2)=4.288,P<0.05).The receiver operator characteristic(ROC)analysis showed that the AUC of serum SP-D to judge the DN complicated with pulmonary infection,the sensitivity and specificity were 0.779(SE=0.056,95%CI=0.669~0.890,P=0.000),0.769 and 0.598,respectively.Conclusion The serum SP-D is helpful to judge the risk of DN complicated with pulmonary infection,and the CC genotype patients are more likely to have pulmonary infection than other patients.