ApoB/ApoA1比值对糖尿病肾病患者进行肾脏替代治疗的预测价值

Predictive value of ApoB/ApoA1 ratio for conducting renal replacement therapy in patients with diabetic kidney disease

目的 探讨载脂蛋白B(ApoB)/载脂蛋白A1(ApoA1)比值对糖尿病肾病(DKD)患者进行肾脏替代治疗的预测价值。方法 选取2017年6月至2020年5月在该院就诊的107例DKD患者为研究对象,随访1年。根据随访期间DKD患者是否行肾脏替代治疗分为肾脏替代治疗组和非肾脏替代治疗组。应用全自动生化分析仪检测血浆ApoB、ApoA1水平,并计算ApoB/ApoA1比值。采用受试者工作特征(ROC)曲线分析ApoB/ApoA1比值对DKD患者进行肾脏替代治疗的预测价值,采用多因素Logistic回归分析DKD患者进行肾脏替代治疗的预测因素。结果 随访1年,42例患者进行肾脏替代治疗,65例患者未进行肾脏替代治疗。肾脏替代治疗组血清血红蛋白(Hb)、肾小球滤过率(eGFR)低于非肾脏替代治疗组,而血肌酐(Scr)、胱抑素C(CysC)水平高于非肾脏替代治疗组(P<0.05)。肾脏替代治疗组ApoB、ApoB/ApoA1比值明显高于非肾脏替代治疗组(P<0.05)。ApoB/ApoA1比值与CysC呈正相关(r=0.538,P<0.05),与Hb、eGFR呈负相关(r=-0.413、-0.622,P<0.05)。ApoA1、ApoB预测DKD患者进行肾脏替代治疗的曲线下面积(AUC)分别为0.678(95%CI:0.586~0.778)、0.726(95%CI:0.658~0.793)。ApoA1预测的灵敏度为64.4%,特异度为65.2%;ApoB预测的灵敏度为76.4%,特异度为63.2%。ApoB/ApoA1比值预测DKD患者进行肾脏替代治疗的AUC为0.871(95%CI:0.784~0.946),灵敏度为83.1%,特异度为84.5%。多因素Logistic回归分析结果显示:模型1(未校正前)、模型2(校正性别、年龄、体质量指数、吸烟史、饮酒史、高血压史、收缩压、舒张压后)、模型3(在模型2基础上再校正相关指标)的OR及95%CI分别为1.92(95%CI:1.28~2.87)、2.17(95%CI:1.53~3.36)、2.02(95%CI:1.45~3.12),升高的ApoB/ApoA1比值是DKD患者进行肾脏替代治疗的独立预测因素(P<0.05)。结论 进行肾脏替代治疗的DKD患者ApoB/ApoA1比值升高,且ApoB/ApoA1比值对DKD患者进展到需肾脏替代治疗具有一定的预测价值,可能成为判断DKD病情恶化的生物标志物,ApoB/ApoA1比值升高预示预后不良。

Objective To investigate the predictive value of ApoB/ApoA1 ratio for the renal replacement therapy in the patients with diabetic kidney disease(DKD).Methods One hundred and seven patients with DKD treated in this hospital from June 2017 to May 2020 were selected as the research subjects.The patients were followed up for 1 year and divided into the renal replacement therapy group(42 cases) and non-renal replacement group(65 cases) according to whether conducting the renal replacement therapy.The automatic biochemical analyzer was used to detect serum ApoB and ApoA1 levels, and the ApoB/ApoA1 ratio was calculated.The receiver operating characteristic(ROC) curve was used to analyze the predictive value of the ApoB/ApoA1 ratio for conducting the renal replacement therapy in the patients with DKD,and the multivariate Logistics regression analysis was used to analyze the predictive factors for conducting the renal replacement therapy in DKD patients.Results During the one year follow-up, 42 patients received renal replacement therapy, and 65 patients did not receive renal replacement therapy.Serum hemoglobin(Hb) level and glomerular filtration rate(eGFR) in the renal replacement therapy group were lower than those in the non-renal replacement therapy group, while serum creatinine(Scr) and cystatin C(CysC) levels were higher than those in the non-renal replacement therapy group(P<0.05).The ApoB level and ApoB/ApoA1 ratio in the renal replacement therapy group were significantly higher than those in the non-renal replacement therapy group(P<0.05).The ApoB/ApoA1 ratio was positively correlated with CysC(r=0.538,P<0.05),and negatively correlated with Hb and eGFR(r=-0.413,-0.622,P<0.05).The areas under the ROC curve(AUC) of ApoA1 and ApoB for the prediction of conducting the renal replacement therapy in the patients with DKD were 0.678(95%CI:0.586-0.778) and 0.726(95%CI:0.658-0.793),respectively.The sensitivity of ApoA1 prediction was 64.4% and the specificity was 65.2%;the sensitivity of ApoB prediction was 76.4% and the specificity was 63.2%.AUC of ApoB/ApoA1 ratio for the prediction of conducting the renal replacement therapy in the patients with DKD was 0.871(95%CI:0.784-0.946),the sensitivity was 83.1%,and the specificity was 84.5%.The multivariate Logistic regression analysis results showed that OR and 95%CI in the model 1(before adjustment),model 2(adjusting for gender, age, body mass index, smoking history, drinking history, history of hypertension, systolic blood pressure, diastolic blood pressure) and model 3(adjusting the related indicators under the basis of the model 2) were 1.92(95%CI:1.28-2.87),2.17(95%CI:1.53-3.36) and 2.02(95%CI:1.45-3.12) respectively, and the elevated ApoB/ApoA1 ratio was an independent predictive factor of conducting the renal replacement therapy in DKD patients(P<0.05).Conclusion The ApoB/ApoA1 ratio in the patients with DKD progression for conducting the renal replacement therapy is increased, moreover the ApoB/ApoA1 ratio has a certain predictive value for the patients with DKD progression to conduct the renal replacement therapy, which may become a biomarker for judging the disease deterioration of DKD.The increase of ApoB/ApoA1 ratio predicts the poor prognosis.