血清骨桥蛋白浓度与糖尿病肾病进展及肾功能的关系

Relationship between serum osteopontin concentration and progression of diabetic nephropathy and renal function

目的分析血清骨桥蛋白(osteopontin,OPN)浓度与糖尿病肾病(diabetic nephropathy,DN)的病情进展以及肾功能的关系。方法选择2019年3月至2021年3月入苏州大学附属张家港医院首次确诊2型糖尿病(diabetes mellitus type 2,T2DM)患者共124例,根据尿蛋白/肌酐比值(urinary protein-creatinine ratio,UACR)将其分为正常组20例(<30 mg/g)、微量组41例(30≤,≤300 mg/g)、大量组30例[>300 mg/g且估算肾小球滤过率(estimated glomerular filtration rate,eGFR)≥90 mL·min^(-1)·(1.73m^(2))^(-1)]和肾功能损害组33例[eGFR<90 mL·min^(-1)·(1.73m^(2))^(-1)],另选择非T2DM健康体检者40名为对照组。采用ELISA法检测血清OPN浓度。结果与对照组比较,T2DM患者血清OPN浓度降低;随着UACR增加,T2DM患者血清OPN浓度逐渐降低,肾功能损害组血清OPN浓度最低,差异均有统计学意义(P<0.05)。Pearson相关分析显示,OPN浓度与肾功能指标UACR和血肌酐(serum creatinine,Scr)呈负相关,与eGFR呈正相关(P<0.05)。单因素和多因素Logistic回归分析显示,糖尿病病程、空腹血糖、UACR、eGFR、Scr和OPN与DN的病情进展和肾功能损害密切相关(P<0.05)。受试者工作曲线分析显示,OPN浓度诊断DN患者病情进展和肾功能损害的曲线下面积分别为0.812和0.866(P<0.05)。结论DN患者血清OPN浓度降低与病情进展和肾功能损害相关,有望成为早期评估疾病严重程度的重要生化指标。

Objective To explore the relationship between serum osteopontin(OPN)concentration and the progression of diabetic nephropathy(DN)and renal function.Methods From March 2019 to March 2021,124 patients with type 2 diabetes mellitus(T2DM)were recruited and assigned into normal group(<30 mg/g,n=20),microgroup(30~300 mg/g,n=41),large group[>300 mg/g and estimated glomerular filtration rate eGFR≥90 mL·min^(-1)·(1.73m^(2))^(-1),n=30]and renal function impairment group[eGFR<90 mL·min^(-1)·(1.73m^(2))^(-1),n=33]according to urinary albumin/creatinine ratio(UACR).Another 40 healthy persons without T2DM were selected as control group.The serum concentration of OPN was detected by enzyme-linked immunosorbent assay(ELISA).Results Compared with control group,serum concentration of OPN was lower in T2DM patients;with a rising level of UACR,serum OPN declined gradually and serum OPN was the lowest in renal function impairment group(P<0.05).Pearson’s analysis showed that OPN concentration was correlated negatively with UACR and serum creatinine(Scr)and positively with estimated glomerular filtration rate(eGFR,P<0.05).Univariate and multivariate Logistic regression analysis showed that duration of diabetes,fasting blood glucose,UACR,eGFR,Scr and OPN were closely correlated with progression of DN and renal function(P<005).Receiver operating curve(ROC)analysis showed that the area under the curve(AUC)of OPN concentration for diagnosing DN progression and renal function were 0.812 and 0.866 respectively(P<0.05).Conclusion In DN patients,a decline of serum osteopontin concentration is associated with disease progression and renal function injury.It is expected to become an important biochemical parameter for early assessment of disease severity.