糖尿病肾病患者血清CTRP3、ANGPTL4和ATX水平变化及临床意义

Changes and clinical significance of serum CTRP3,ANGPTL4 and ATX levels in patients with diabetic nephropathy

目的探讨糖尿病肾病(DN)患者血清补体C1q肿瘤坏死因子相关蛋白-3(CTRP3)、血管生成素样蛋白4(ANGPTL4)和自分泌蛋白(ATX)的水平变化及临床意义。方法选择2018年1月至2019年12月在该院就诊的2型糖尿病患者163例,根据尿清蛋白排泄率(UAER)将患者分为单纯糖尿病组(65例)和DN组(98例)。选择同期健康体检者45例为对照组。DN组患者又分为早期DN组(20μg/min≤UAER<200μg/min)50例,临床DN组(UAER≥200μg/min)48例。比较单纯糖尿病组、DN组、对照组血清CTRP3、ANGPTL4、ATX和胱抑素C(Cys C)水平;比较单纯糖尿病组、临床DN组、早期DN组血清CTRP3、ANGPTL4、ATX和Cys C水平;分析血清CTRP3、ANGPTL4、ATX和Cys C对DN的诊断效能;分析DN患者血清CTRP3、ANGPTL4和ATX水平间的相关性。结果DN组和单纯糖尿病组血清CTRP3水平明显低于对照组,ANGPTL4、ATX和Cys C水平明显高于对照组,差异有统计学意义(P<0.05);而DN组血清CTRP3水平明显低于单纯糖尿病组,ANGPTL4、ATX和Cys C水平明显高于单纯糖尿病组,差异有统计学意义(P<0.05)。临床DN组和早期DN组血清CTRP3水平明显低于单纯糖尿病组,ANGPTL4、ATX和Cys C水平明显高于单纯糖尿病组,差异有统计学意义(P<0.05);而临床DN组血清CTRP3水平明显低于早期DN组,ANGPTL4、ATX和Cys C水平明显高于早期DN组,差异有统计学意义(P<0.05)。血清CTRP3、ANGPTL4和ATX联合检测诊断DN的灵敏度为88.0%,特异度为98.5%,AUC为0.971,明显高于各项指标单独检测(P<0.001)。DN患者血清CTRP3水平与ANGPTL4和ATX水平呈负相关(r=-0.681、-0.729,P<0.05),而血清ANGPTL4水平与ATX水平呈正相关(r=0.812,P<0.05)。结论血清CTRP3、ANGPTL4和ATX参与了DN的发生、发展,联合检测血清CTRP3、ANGPTL4和ATX能够明显提高对DN的诊断效能,值得推广应用。

Objective To investigate the changes and clinical significance of serum complement C1q tumor necrosis factor-related protein-3(CTRP3),angiopoietin-like protein 4(ANGPTL4)and autotaxin(ATX)levels in patients with diabetic nephropathy(DN).Methods A total of 163 patients with type 2 diabetes who were treated in this hospital from January 2018 to December 2019 were selected,and the patients were divided into simple diabetes group(65 cases)and DN group(98 cases)according to the urinary albumin excretion rate(UAER).A total of 45 healthy subjects were selected as the control group.The patients in the DN group were further divided into the early DN group(20μg/min≤UAER<200μg/min)with 50 cases and the clinical DN group(UAER≥200μg/min)with 48 cases.Compared the serum CTRP3,ANGPTL4,ATX and cystatin C(Cys C)levels in the simple diabetes group,DN group and control group.Compared the serum CTRP3,ANGPTL4,ATX and Cys C levels in the simple diabetes group,clinical DN group and early DN group.Analyzed the diagnostic efficacy of serum CTRP3,ANGPTL4,ATX and Cys C for DN.The correlation between serum CTRP3,ANGPTL4 and ATX levels in DN patients was analyzed.Results The levels of serum CTRP3 in the DN group and the simple diabetes group were significantly lower than those in the control group,and the levels of serum ANGPTL4,ATX and Cys C were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).The level of serum CTRP3 in the DN group was significantly lower than that in the simple diabetes group,and the levels of serum ANGPTL4,ATX and Cys C were significantly higher than those in the simple diabetes group,and the differences were statistically significant(P<0.05).The levels of serum CTRP3 in the clinical DN group and early DN group were significantly lower than those in the simple diabetes group,and the levels of serum ANGPTL4,ATX and Cys C were significantly higher than those in the simple diabetes group,and the differences were statistically significant(P<0.05).However,the level of serum CTRP3 in the clinical DN group was significantly lower than that in the early DN group,and the levels of serum ANGPTL4,ATX and Cys C were significantly higher than those in the early DN group,and the differences were statistically significant(P<0.05).The combined detection of serum CTRP3,ANGPTL4 and ATX had a sensitivity of 88.0%,a specificity of 98.5% and an AUC of 0.971 for the diagnosis of DN,which were significantly higher than those of the three indicators alone(P<0.001).Serum CTRP3 levels in DN patients were negatively correlated with ANGPTL4 and ATX levels(r=-0.681,-0.729,P<0.05),while serum ANGPTL4 was positively correlated with ATX levels(r=0.812,P<0.05).Conclusion Serum CTRP3,ANGPTL4 and ATX are involved in the occurrence and development of DN.Combined detection of serum CTRP3,ANGPTL4 and ATX could significantly improve the diagnostic efficiency of DN,which is worthy of popularization and application.