2型糖尿病肾病患者血清Smad1、BMP4水平变化及其临床意义

Changes and clinical significance of serum Smad1 and BMP4 levels in patients with type 2 diabetic nephropathy

目的探讨血清人信号转导分子Smad1、骨形态发生蛋白4(BMP4)水平变化在2型糖尿病肾病患者中的临床意义。方法选取2020年6月至2021年2月该院接诊治疗的80例2型糖尿病患者为研究对象,根据2型糖尿病Mogensen分期标准将患者分为单纯糖尿病(NON)组、2型糖尿病肾病微量蛋白尿(MIC)组、2型糖尿病肾病临床蛋白尿(MAC)组、晚期2型糖尿病肾病(CKD)组,每组20例。同时以20例体检健康志愿者为对照组。采用酶联免疫吸附试验检测血清Smad1、BMP4水平,采用全自动生化分析仪检测血脂[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)]、尿清蛋白(UAlb)、尿肌酐(Cr)、血肌酐水平,估算肾小球过滤率(eGFR),采用Pearson相关分析不同参数间的相关性。结果5组UAlb/Cr比值、eGFR及血清TC、TG、LDL-C、HDL-C水平比较,差异均有统计学意义(P<0.05);5组间任意两组比较,差异均有统计学意义(P<0.05)。5组血清Smad1、BMP4水平按对照组、NON组、MIC组、MAC组、CKD组的顺序依次升高,差异均有统计学意义(P<0.05);5组间任意两组比较,差异均有统计学意义(P<0.05)。Pearson相关分析显示,Smad1水平与UAlb/Cr、TC、TG、LDL-C均呈正相关(r=0.510、0.404、0.591、0.631,P<0.05),与HDL-C均呈负相关(r=-0.545,P<0.05);BMP4水平与UAlb/Cr、TC、TG、LDL-C均呈正相关(r=0.399,0.612、0.466、0.611,P<0.05),与HDL-C呈负相关(r=-0.416,P<0.05)。Smad1、BMP4水平与2型糖尿病肾病病情严重程度呈正相关(r=0.632、0.605,P<0.05)。结论Smad1、BMP4与2型糖尿病肾病发展具有一定相关性,对2型糖尿病肾病患者病情及预后判断具有一定临床价值。

Objective To investigate the clinical significance of the changes of serum human signal transduction molecule Smad1 and bone morphogenetic protein 4(BMP4)levels in patients with type 2 diabetic nephropathy.Methods A total of 80 patients with type 2 diabetes who were admitted and treated in this hospital from June 2020 to February 2021 were selected as the research objects.According to the staging criteria of Mogensen,the patients were divided into the simple diabetes(NON)group,the type 2 diabetic nephropathy microproteinuria(MIC)group,the type 2 diabetic nephropathy clinical proteinuria(MAC)group,and the advanced type 2 diabetic nephropathy(CKD)group,with 20 cases in each group.At the same time,20 volunteers with healthy physical examination were used as the control group.The serum levels of Smad1 and BMP4 were detected by enzyme-linked immunosorbent assay.The levels of blood lipids[total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)],urinary albumin(UAlb),urinary creatinine(Cr)and serum creatinine were detected by automatic biochemical analyzer,and the glomerular filtration rate(EGFR)was estimated,and the Pearson correlation was used to analyze the correlation between different parameters.Results There were statistically significant differences in the UAlb/Cr ratio,eGFR and the serum levels of TC,TG,LDL-C and HDL-C among the five groups(P<0.05);and there were statistically significant differences between any two groups among the 5 groups(P<0.05).The serum levels of Smad1 and BMP4 in the 5 groups increased in the order of the control group,the NON group,the MIC group,the MAC group and the CKD group,and the differences were statistically significant(P<0.05);there were statistically significant differences between any two groups among the 5 groups(P<0.05).Pearson correlation analysis showed that the level of Smad1 was positively correlated with UAlb/Cr,TC,TG,LDL-C(r=0.510,0.404,0.591,0.631,P<0.05),and negatively correlated with HDL-C(r=-0.545,P<0.05).The level of BMP4 was positively correlated with UAlb/Cr,TC,TG,LDL-C(r=0.399,0.612,0.466,0.611,P<0.05),and negatively correlated with HDL-C(r=-0.416,P<0.05).The levels of Smad1 and BMP4 were positively correlated with the severity of type 2 diabetic nephropathy(r=0.632,0.605,P<0.05).Conclusion Smad1 and BMP4 have a certain correlation with the development of type 2 diabetic nephropathy,and have certain clinical value in the judgment of the condition and prognosis of patients with type 2 diabetic nephropathy.