皮肤晚期糖基化终末产物与2型糖尿病肾病的相关性

Relationship between skin advanced glycation end products and type 2 diabetic nephropathy

目的探讨皮肤晚期糖基化终末产物(AGEs)同蛋白尿之间的联系。方法选取2020年12月-2022年05月在合肥市第二人民医院内分泌科住院治疗的105例2型糖尿病(T2DM)患者,按照尿白蛋白/肌酐(ACR)水平分为3组,T2DM组26例;微量蛋白尿(MPRO)组53例;大量蛋白尿组(HPRO组)26例。各组均行皮肤AGEs检测;收集临床资料;分析各组皮肤AGEs水平和其它指标。结果在病程、年龄、血肌酐(Scr)与皮肤AGEs方面,MPRO组与HPRO组存在显著差异(P<0.05);与T2DM组相比,其余2组皮肤AGEs水平皆为明显偏高(P<0.05),且HPRO组较MPRO组明显偏高(P<0.05);由Spearman相关分析可知,皮肤AGEs水平显著相关于ACR(P<0.05);由Logistic回归分析可知,皮肤AGEs、HbA1c与糖尿病(DM)病程皆为DN的独立风险因子(P<0.05);皮肤AGEs用于筛查糖尿病肾病(DN)的ROC曲线下面积(AUC)是0.817,AGEs最佳切点值是73.2 a.u.,特异度与灵敏度分别为76.92%、78.48%。结论2型糖尿病患者皮肤AGEs水平与ACR呈正相关,皮肤AGEs可作为DN的预测因子,可能有助于DN的诊断、治疗和预防。

Objective To explore the relationship between skin advanced glycation end products(AGEs)and proteinuria.Methods 105 patients with type 2 diabetes mellitus(T2DM)who were hospitalized in the Department of Endocrinology of the Second People's Hospital of Hefei from December 2020 to May 2022 were selected and divided into three groups according to urinary albumin/creatinine ratio(ACR),namely the T2DM group(n=26),the microproteinuria(MPRO)group(n=53),and the heavy proteinuria(HPRO)group(n=26).The skin AGEs of each group were detected.Some clinical data of the patients were collected.The levels of skin AGEs and other indicators in each group were analyzed.Results There were significant differences in the course of disease,age,serum creatinine(Scr)and skin AGEs between MPRO group and HPRO group(P<0.05).Compared with T2DM group,the levels of skin AGEs in the other two groups were significantly higher(P<0.05),and the HPRO group was significantly higher than the MPRO group(P<0.05).Spearman correlation analysis showed that skin AGEs levels were significantly correlated with ACR(P<0.05).Logistic regression analysis showed that skin AGEs,glycosylated hemoglobin(HbA1c)and the course of diabetes mellitus were all independent risk factors of diabetic nephropathy(DN)(P<0.05).The area under the receiver operating characteristic(ROC)curve(AUC)of skin AGEs for screening DN was 0.817,and the optimal cut-off value of AGEs was 73.2 a.u.,and the specificity and sensitivity were 76.92%and 78.48%,respectively.Conclusion The levels of skin AGEs in patients with type 2 diabetes are positively correlated with ACR.Skin AGEs can be used as a predictor of DN,which may be helpful to the diagnosis,treatment and prevetion of DN.