尿液信号素3A与糖尿病肾病患者肾脏损伤及远期预后的关系

Relationship between urinary signalin 3A and renal injury and long-term prognosis in diabetic nephropathy

目的分析尿液信号素3A(SEMA3A)与糖尿病肾病患者肾脏损伤及远期预后的关系。方法选择本中心2017年6月至2018年6月接诊的158例糖尿病肾病患者为研究对象,根据入组时24 h尿白蛋白水平,分为微量蛋白尿组96例和大量蛋白尿组62例,另选50例单纯2型糖尿病患者作为对照组。比较3组尿液SEMA3A水平,分析糖尿病肾病患者尿液信号素3A与肾脏损伤指标的关系。所有患者随访24个月,观察终末期肾病发生情况,采用受试者工作特征曲线(ROC)下面积(AUC)评价尿液SEMA3A对终末期肾病的预测价值。结果大量蛋白尿组尿液SEMA3A水平为(0.318±0.095)ng/ml,高于微量蛋白尿组的(0.096±0.038)ng/ml和对照组的(0.026±0.012)ng/ml,差异均有统计学意义(t=8.451、6.329,均P<0.05);微量蛋白尿组尿液SEMA3A水平高于对照组,差异有统计学意义(t=4.076,P<0.05)。大量蛋白尿组Scr[(250.43±28.72)μmol/L]、BUN[(15.48±3.64)mg/L]、CysC[(5.63±1.72)mg/L]水平均高于微量蛋白尿组[(186.94±16.47)μmol/L、(11.52±1.57)mg/L、(2.14±0.53)mg/L],GFR[(38.74±4.86)ml/(min·173 m^(2))]低于微量蛋白尿组[(47.15±7.79)ml/(min·173 m^(2))],差异均有统计学意义(t=26.428、5.624、4.748,均P<0.05)。经Pearson相关性分析,糖尿病肾病患者尿液SEMA3A水平与Scr、BUN和CysC均呈正相关(r=0.265、0.212、0.203,均P<0.05),与GFR呈负相关(P<0.05)。多因素Logistic回归分析显示,尿液SEMA3A是糖尿病肾病患者发生终末期肾病的独立危险因素(P<0.05);模型2显示尿液SEMA3A水平每升高2 ng/ml,终末期肾病发生的风险提高约28%。经ROC曲线分析,尿液SEMA3A预测糖尿病肾病患者发生终末期肾病的AUC为0.918,明显大于GFR的0.671,差异有统计学意义(P<0.05)。结论尿液SEMA3A与糖尿病肾病患者肾脏损伤程度呈正相关,对终末期肾病的预测价值较高。

Objective To analyze the relationship between urine SEMA3A(SEMA3A)and renal injury and long-term prognosis in patients with diabetic nephropathy.Methods A total of 158 diabetic nephropathy patients admitted to our center from June 2017 to June 2018 were selected as the study subjects.According to the 24 h urinary albumin level at the time of enrollment,they were divided into microproteinuria group(96 cases)and massive proteinuria group(62 cases),and 50 patients with pure type 2 diabetes were selected as the control group.Urine SEMA3A levels were compared among the three groups,and the relationship between urine sema3A and kidney injury indexes in diabetic nephropathy patients was analyzed.All patients were followed up for 24 months to observe the occurrence of end-stage renal disease,and the predictive value of urine SEMA3A for end-stage renal disease was evaluated using area under receiver operating characteristic curve(ROC)(AUC).Results The SEMA3A level in the macroproteinuria group was(0.318±0.095)ng/ml,which was higher than that in the microproteinuria group(0.096±0.038)ng/ml and the control group(0.026±0.012)ng/ml.The differences were statistically significant(t=8.451,6.329,both P<0.05).The urinary SEMA3A level in microproteinuria group was higher than that in control group,and the difference was statistically significant(t=4.076,P<0.05).The levels of Scr[(250.43±28.72)μmol/L],BUN[(15.48±3.64)mg/L]and CysC[(5.63±1.72)mg/L]in the large proteinuria group were higher than those in the small proteinuria group[(186.94±16.47)μmol/L,(11.52±1.57)mg/L,(2.14±0.53)mg/L],GFR was lower than microproteinuria group,the differences were statistically significant(t=26.428,5.624,4.748,P<0.05).By Pearson correlation analysis,urine SEMA3A level in diabetic nephropathy patients was positively correlated with Scr,BUN and CysC(r=0.265,0.212,0.203,all P<0.05),and negatively correlated with GFR(P<0.05).Multivariate Logistic regression analysis showed that urine SEMA3A was an independent risk factor for ESRD in diabetic nephropathy patients(P<0.05).Model 2 showed that for every 2 ng/ml increase in urinary SEMA3A levels,the risk of end-stage renal disease increased by about 28%.According to ROC curve analysis,the AUC of urine SEMA3A in predicting the occurrence of end-stage renal disease in diabetic nephropathy patients was 0.918,which was significantly greater than that of GFR(0.671),with statistical significance(P<0.05).Conclusion Urinary SEMA3A is positively correlated with renal injury in patients with diabetic nephropathy,and has high predictive value for end-stage renal disease.