基于血清TFF3、SFRP5、Gal-3和NES-1的糖尿病肾病诊断预测公式

Diagnostic prediction formula for diabetic nephropathy based on serum TFF3, SFRP5, Gal-3 and NES-1

目的探讨血清三叶因子3(TFF3)、分泌型卷曲相关蛋白5(SFRP5)、半乳糖凝集素3(Gal-3)和新饱食分子蛋白1(NES-1)在单纯2型糖尿病(T2DM)、糖尿病肾病(DN)、非DN的慢性肾脏病(CKD)患者及健康对照者中的表达情况和相关性,探讨上述指标与DN的关系,建立联合使用上述4项指标的DN诊断预测公式。方法选择2017年4月至2019年6月于天津市第三中心医院住院的T2DM、DN和CKD患者各36例,同时选取36名健康志愿者作为健康对照组。各组研究对象空腹8~10 h取静脉血离心,收集血清进行检测,比较血清TFF3、SFRP5、Gal-3、NES-1的水平,并进行Pearson相关性分析。将研究对象按是否诊断DN进行再次分组,分为DN组和非DN组(包括健康对照组、T2DM组和CKD组)。对上述4项指标进行二元logistic回归分析,建立DN诊断预测模型,并进一步通过受试者工作特征曲线(ROC)进行验证。结果DN组的血清TFF3、Gal-3和NES-1水平均明显高于健康对照组、T2DM组和CKD组(均P<0.05),而DN组的血清SFRP5水平明显低于健康对照组、T2DM组和CKD组(均P<0.05),且4组间上述4项指标比较,差异均具有统计学意义(均P<0.001)。Pearson相关性分析结果显示,上述4项指标之间具有明显的相关性(均P<0.01)。TFF3、SFRP5、Gal-3和NES-1的ROC曲线下面积分别为0.849、0.807、0.882和0.841,4项指标联合诊断的曲线下面积(0.986)明显高于单一指标,差异均具有统计学意义(Z=3.75、4.08、3.63、4.06,均P<0.05)。结论基于血清TFF3、SFRP5、Gal-3和NES-1建立的联合预测模型能有效提高DN的诊断准确性,为DN的临床诊断提供重要依据。

Objective To investigate the expression and correlation of serum trefoil factor 3(TFF3),serum secreted frizzled-related protein 5(SFRP5),galectin-3(Gal-3),and nesfatin-1(NES-1)in patients with type 2 diabetes(T2DM),diabetic nephropathy(DN),chronic kidney disease(CKD),and healthy controls.To explore the relationship between the above factors and the diagnosis of DN and to establish a diagnostic formula for the diagnosis of DN combined with the above four factors.Methods In each group 36 patients hospitalized in Tianjin Third Central Hospital from April 2017 to June 2019 were enrolled.36 healthy volunteers were also chosen as the healthy control group.After 8 to 10 hours of fasting,the venous blood of the subjects in each group was centrifuged,the serum was collected for detection,the serum levels of TFF3,SFRP5,Gal-3,and NES-1 were compared,and the Pearson correlation analysis was performed.According to whether the diagnosis of DN was repeated,the subjects were divided into the DN group and the non-DN group(including a healthy control group,T2DM group,and CKD group).The four datasets were analyzed by binary logistic regression,and the diagnostic prediction model of DN was established,which was further verified by receiver operating characteristic(ROC).Results The serum levels of TFF3,Gal-3 and NES-1 in DN groups were significantly higher than those in healthy control group,T2DM group and CKD group(all P<0.05),but the serum level of SFRP5 in DN group was significantly lower than that in healthy control group,T2DM group and CKD group(all P<0.05).The differences between the four groups in the four aforementioned indicators were all statistically significant(all P<0.001).The Pearson correlation analysis showed that there was a significant correlation between the above four indicators(all P<0.01).The area under the ROC curve of TFF3,SFRP5,Gal-3,and NES-1 was 0.849,0.807,0.882,and 0.841 respectively.The area under the curve diagnosed by the combination of four indicators(0.986)was significantly higher than that of a single indicator,and the difference was statistically significant(Z=3.75,4.08,3.63,4.06,all P<0.05).Conclusions The joint prediction model based on serum TFF3,SFRP5,Gal-3,and NES-1 can effectively improve the diagnostic accuracy of DN and provide an important basis for clinical diagnosis of DN.