血清MCP-1、C1q和IGF-1表达与糖尿病肾病病情严重程度和血液透析治疗效果的关系

The relationship between the expression levels of serum MCP-1,C1q and IGF-1 and the severity of the disease in DN patients

目的探讨血清单核细胞趋化蛋白1(MCP-1)、补体1q(C1q)和胰岛素样生长因子Ⅰ(ICF-1)表达水平与糖尿病肾病(DKD)患者的病情严重程度和血液透析治疗效果的关系。方法选取2016年1月至2019年1月于本院血液净化中心治疗的306例维持性血液透析DKD患者为DKD组,根据是否合并冠心病(CHD)分为CHD组(167例)和非CHD组(139例);并根据Mogensen标准分为肾功能损害组(54例)、大量蛋白尿组(112例)、微量蛋白尿组(140例);另选取同时期来本院体检的健康者150例为健康组。收集所有研究对象一般资料,并检测其肾功能指标、血脂指标、血清指标及空腹血糖(FBG)和尿白蛋白(UAIb)/肌酐(Cr)。采用Pearson相关分析MCP-1、C1q、IGF-1间及与UAlb/Cr相关性;有序多分类logistic回归分析DKD病情进展影响因素;绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),判断MCP-1、C1q、ICF-1对DKD病情的预测价值。结果DKD组的血清MCP-1、C1q、IGF-1水平明显高于健康组(P<0.05);CHD组的血清MCP-1、Clq、ICF-1水平明显高于非CHD组(P<0.05);Pearson相关分析显示,DKD患者的血清MCP-1与Clq、IGF-1呈正相关(P<0.05),Clq与IGF-1呈正相关(P<.0.05),且三者与UAlb/Cr呈正相关(P<0.05);有序多分类logistic回归分析显示血清MCP-1、Clq、ICF-1水平均为DKD病情进展的影响因素(P<0.05);血清MCP-1、C1q、IGF-1联合诊断的特异度和灵敏度及AUC均大于单独诊断。结论血液透析DN患者的血清MCP-1、Clq、IGF-1水平与DKD病情进展呈正相关,合并CHD患者MCP-1、Clq、IGF-1水平更高,联合诊断预测价值优于单--指标,可作为预测DKD病情严重程度和血液透析治疗效果的指标。

Objective To investigate the expression levels of serum monocyte chemoattractant protein-I(MCP-1),complement lq(C1q)and insulin-like growth factor 1(ICF-1)and the severity of diabetic kidney disease(DKD)Relationship with the effectiveness of hemodialysis treatment.Methods From January 2016 to January 2019,306 patients with maintenance hemodialysis DKD ad-mited to our hospitals blood purification center were selected as the DN group,and divided into CHD group(167 cases)and non-CHD group according to whether CHD was combined(139 cases),and divided into renal function impairment group(54 cases),a large amount of proteinuria group(112 ca-ses),and a small amount of proteinuria group(140 cases)according to Mogensen criteria,and 150 healthy people were in the healthy group.The general data of all the research subjects,and test their renal function indexes,blood lipid indexes,serum indexes and FBG And UAlb/Cr were collected.Pearson correlation analysis was used to analyze the correlation between MCP-1,Clq,IGF-I and UAlb/Cr;ordered multi-class logistic regression analysis of the factors affecting the progression of DKD disease.ROC was drawn,AUC was calculated,and predictive value of MCP-1,Clq,IGF-1 in DKD was detemined.Results Serum MCP-1,Clq and IGF-1 levels in the DKD group were significantly higher than those in the healthy group(P<0.05).Serum MCP-1,Clq and ICF-1 levels in the CHD group were significantly higher than those in the non-CHD group(P<0.05),Pearson correlation a-nalysis showed that serum MCP-1 and Clq,IGF-I were positirely correlated and Clq were positively correlated with IGF-1 in DKD patients(P<0.05);ordered multi-class logistic regression analysis showed serum MCP-1,Clq,ICF-1 levels were influencing factors of DKD disease progression(P<0.05);the specificity and sensitivity of combined diagnosis of serum MCP-I,Clq,ICF-1 and AUC were greater than those of single diagnosis.Conclusions Serum MCP-1,C1q,IGF-1 levels in hemo-dialysis DKD patients are positively correlated with DKD condition,MCP-1,Clq,ICF-1 levels in pa-tients with CHD are higher,the combined diagnostic predictive value is better than a single index,can be used as Index to predict the severity of DKD disease and the effectiveness of hemodialysis treat-ment.