血清淋巴管生成因子介导糖尿病肾病进展的相关性

Correlation between serum lymphangiogenic factor and progression of diabetic nephropathy

目的:分析血清淋巴管生成因子[1-磷酸鞘氨醇(SIP)、基质细胞衍生因子-1(SDF-1)、血管内皮生长因子-C(VEGF-C)]与糖尿病肾病(DN)患者疾病进展的关系。方法:选取2017年1月至2020年1月江苏扬州大学附属医院就诊的123例DN患者,于首次到院接受治疗当天早晨检测血清淋巴管生成因子及肾脏损伤指标[24 h尿蛋白定量、肾小球滤过率(eGFR)];依据治疗6个月肾功能分期分为进展组(39例)与未进展组(84例),比较两组临床资料,分析治疗前血清淋巴管生成因子与疾病进展的关系。结果:血清SIP、SDF-1及eGFR分别与VEGF-C、24 h尿蛋白定量间呈负相关关系(r=-0.551、-0.733、-0.596、-0.757、-0.565、-0.780,P<0.05);对比两组资料后经回归分析,治疗前肾脏损伤指标及SIP、SDF-1、VEGF-C与DN患者治疗后疾病进展有关(P<0.05);受试者工作特征曲线(ROC曲线)结果显示,治疗前24 h尿蛋白定量、eGFR及血清SIP、SDF-1、VEGF-C水平分别预测DN患者治疗后疾病进展风险的ROC曲线下面积(AUC)分别为0.842(0.765~0.919)、0.823(0.741~0.905)、0.844(0.769~0.919)、0.864(0.801~0.927)、0.832(0.751~0.913),均>0.80,且治疗前24 h尿蛋白定量、eGFR及血清SIP、SDF-1、VEGF-C水平的cut-off值分别为358.405 mg/24 h、60.585 mL·min^(-1)·1.73 m^(-2)、274.385 pg/mL、1.855 ng/mL、173.865 pg/mL时,预测价值均较理想。结论:血清SIP、SDF-1、VEGF-C水平与DN患者肾脏损伤有关,对预测患者治疗后疾病进展风险有一定价值。

Objective:To analyze the relationship between serum lymphangiogenic factors such as sphingosine 1-phosphate(SIP),stromal cell derived factor-1(SDF-1),and vascular endothelial growth factor-C(VEGF-C)and disease progression of patients with diabetic nephropathy(DN).Methods:A total of 123 patients with DN admitted to our hospital from January 2017 to January 2020 were selected.Serum lymphangiogenic factors and renal injury indexes such as 24-hour urinary protein and glomerular filtration rate(eGFR)were detected at the morning of first admission for treatment.The patients were divided into progressive group(39 cases)and non progressive group(84 cases)according to renal function stage at 6 months of treatment.The clinical data of the two groups were compared,and the relationship between serum lymphangiogenic factors before treatment and disease progression was analyzed.Results:Serum SIP,SDF-1 and eGFR were negatively correlated with VEGF-C and 24-hour urinary protein(r=-0.551,-0.733,-0.596,-0.757,-0.565,and-0.780,P<0.05).The indexes of renal injury before treatment and the levels of SIP,SDF-1 and VEGF-C in serum were related to the progression of DN after treatment(P<0.05).The ROC curve showed that the area under the ROC curve(AUC)of 24-hour urine protein,eGFR and serum SIP,SDF-1 and VEGF-C levels before treatment were 0.842(0.765-0.919),0.823(0.741-0.905),0.844(0.769-0.919),0.864(0.801-0.927),and 0.832(0.751-0.913)respectively in predicting the risk of disease progression in patients with DN after treatment,all>0.80.When the cut-off values of 24-hour urine protein,eGFR and serum SIP,SDF-1 and VEGF-C levels before treatment were 358.405 mg/24 h,60.585 mL·min^(-1)·1.73 m^(-2),274.385 pg/mL,1.855 ng/mLand 173.865 pg/mL respectively,the predictive value was ideal.Conclusion:Levels of serum SIP,SDF-1 and VEGF-C are associated with renal injury in patients with DN,which may have certain value in predicting the risk of disease progression in patients after treatment.