糖尿病肾病患者血清Cys C、NGAL、ACR水平与血管病变的相关性

The Correlation Between Serum Cys C, NGAL and ACR Levels andVascular Disease in Patients with Diabetic Nephropathy

目的研究糖尿病肾病(diabetic nephropathy,DN)患者血清胱抑素C(cystatin C,Cys C)、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatase-associated lipid carrier proteins,NGAL)、尿微量白蛋白/肌酐比值(albumin/creatinine ratio,ACR)水平与血管病变的相关性。方法选择本院2019年5月至2020年10月诊治的110例DN患者作为研究对象,进行回顾性分析,均检测患者Cys C、NGAL、ACR水平。另选择同期本院收治的59例单纯糖尿病患者作为对照组,另根据DN患者是否发生大血管病变设为A组(单纯DN,41例)和B组(DN合并大血管病变,69例),比较三组患者血清Cys C、NGAL、ACR水平,并分析上述血清指标与血管病变的相关性。结果B组患者血清Cys C、NGAL、ACR水平均显著高于对照组和A组(P<0.05);两组患者糖尿病病程、糖化血红蛋白和低密度脂蛋白水平比较差异有统计学意义(P<0.05),但年龄、性别等其他临床资料比较差异无统计学意义(P>0.05);Logistic多元回归分析发现Cys C、NGAL、ACR水平、糖尿病病程、糖化血红蛋白均是影响DN患者大血管病变发生的独立危险因素(P<0.05);动脉狭窄组患者血清Cys C、NGAL、ACR水平显著高于动脉内膜正常组和内膜增厚组(P<0.05);血清Cys C、NGAL、ACR水平与血管病变程度呈正相关(P<0.05)。结论DN患者存在血清Cys C、NGAL、ACR水平异常升高,是大血管病变发生的独立危险因素,且其水平与血管病变程度密切相关,可能作为临床诊断或预测DN患者血管病变发生的临床辅助指标。

Objective To study the correlation between serum cystatin C(Cys C),neutrophil gelatase-associated lipid carrier proteins(NGAL)and urine microalbumin/creatinine ratio(ACR)with vascular disease in patients with diabetic nephropathy(DN).Methods A total of 110 patients with DN diagnosed and treated in the hospital were selected as the research subjects between May,2019 and October,2020,while 59 patients with simple diabetes were selected as the control group.A retrospective analysis was performed with this study cohort.Levels of Cys C,NGA,and ACR were detected in all subjects.According to the presence or absence of macrovascular disease,the patients with DN were further divided into group A(simple DN,41 cases)and group B(DN with macrovascular disease,69 cases).Serum levels of Cys C,NGAL and ACR among these three groups were compared,and the correlation between above serum indexes and vascular disease was analyzed.Results Serum Cys C,NGAL and ACR in group B were significantly higher than those in the control group and group A(P<0.05).There were statistically significant differences in the course of diabetes,glycosylated hemoglobin and low-density lipoprotein levels(P<0.05),but other clinical features such as age and gender showed no statistically significant differences(P>0.05).Multivariate logistic regression analysis showed that Cys C,NGAL,ACR,course of diabetes,and glycosylated hemoglobin were independent factors influencing the occurrence of macrovascular disease in patients with DN(P<0.05).Serum Cys C,NGAL and ACR in arterial stenosis group were significantly higher than those in the normal arterial intima group and the intima thickening group(P<0.05).Serum Cys C,NGAL and ACR were positively correlated with the degree of vascular disease(P<0.05).Conclusion Patients with DN have abnormally elevated serum Cys C,NGAL and ACR,which are independent risk factors for macrovascular disease.Furthermore,levels of these markers are closely related to the degree of vascular disease,which indicates that these indicators can be used as clinical auxiliary indicators for clinical diagnosis or prediction of vascular disease in patients with DN.