糖尿病肾病患者氧化应激状态与UACR和Uβ_(2)-MG的相关性

Oxidative stress status and its correlation with UACR and Uβ_(2)-MG levels in patients with diabetic nephropathy

目的分析糖尿病肾病(diabetic nephropathy,DN)患者氧化应激状态及与尿白蛋白/肌酐比值(Urinary albumin/creatinine ratio,UACR)、尿β_(2)-微球蛋白(urinaryβ_(2)-Microglobulin,Uβ_(2)-MG)的相关性,为临床上评估DN患者氧化应激状态提供理论基础。方法选取2020年1月至2021年12月遂宁市中心医院收治DN患者382例,根据患者24 h尿微量白蛋白排泄率分为轻度肾损害组(20μg/min<24h尿微量白蛋白排泄率<200μg/min,n=233)和重度肾损害组(24h尿微量白蛋白排泄率≥200μg/min,n=149),测定所有研究对象氧化应激指标及UACR和Uβ_(2)-MG水平,采用Spearman相关性分析DN患者氧化应激状态与UACR和Uβ_(2)-MG水平的相关性,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)曲线UACR和Uβ_(2)-MG联合预测判断DN患者氧化应激状态效能。结果重度肾损害组血清SOD水平显著低于轻度肾损害组(P<0.05);重度肾损害组血清丙二醛(Malondialdehyde,MDA)水平显著高于轻度肾损害组(P<0.05);重度肾损害组UACR和Uβ_(2)-MG水平显著高于轻度肾损害组(P<0.05);Spearman相关性分析显示DN患者组血清超氧化物歧化酶(Superoxide dismutase,SOD)水平与UACR和Uβ_(2)-MG呈正相关(r=-0.462,0.413,P<0.05);DN患者组血清MDA水平与UACR和Uβ_(2)-MG呈负相关(r=-0.438,-0.459,P<0.05);经ROC曲线分析UACR和Uβ_(2)-MG联合预测判断DN患者氧化应激状态的AUC为0.689,敏感度为79.84%,特异度为83.45%。结论DN患者氧化应激可加快DN肾脏病变的进展,其氧化应激状态与UACR和Uβ_(2)-MG水平密切相关,可通过UACR和Uβ_(2)-MG水平判断机体氧化应激情况,防止患者DN肾脏病变进展。

Objective To analyze oxidative stress status and its correlation with urinary albumin creatinine ratio(UACR)and urinaryβ_(2) microglobulin(Uβ_(2)-MG)in patients with diabetic nephropathy(DN),and to provide a theoretical basis for clinical evaluation of oxidative stress status in DN patients.Methods A total of 382 DN patients admitted to our hospital from January 2020 to December 2021 were selected.According to the 24h urinary microalbumin excretion rate(24h UAER),the patients were divided into mild renal injury group(20μg/min<24h UAER<200μg/min,n=233)and severe renal injury group(24h UAER≥200μg/min,n=149).Oxidative stress indicators as well as UACR and Uβ_(2)-MG levels in all subjects were determined.Spearman correlation was used to analyze the correlation between oxidative stress status and the levels of UACR and Uβ_(2)-MG in DN patients.The combined ROC curve of UACR and Uβ_(2)-MG was used to predict the efficacy of oxidative stress status in DN patients.Results The level of SOD in the severe renal injury group was significantly lower than that in the mild renal injury group(P<0.05).The serum MDA level in the severe renal injury group was significantly higher than that in the mild renal injury group(P<0.05).The levels of UACR and Uβ_(2)-MG in the severe renal injury group were significantly higher than those in the mild renal injury group(P<0.05).Spearman correlation analysis showed that SOD level was positively correlated with UACR and Uβ_(2)-MG levels in DN patients(r=-0.462,0.413,P<0.05).The serum MDA level was negatively correlated with UACR and Uβ_(2)-MG levels in DN patients(r=-0.438,-0.459,P<0.05).The ROC curve analysis showed that the combined AUC of UACR and Uβ_(2)-MG to predict the oxidative stress status of DN patients was 0.689,the sensitivity was 79.84%,and the specificity was 83.45%.Conclusion Oxidative stress in DN patients can accelerate the pathological progression of nephropathy.The oxidative stress status is closely related to the levels of UACR and Uβ_(2)-MG,which can be used to judge the oxidative stress of the body and prevent the pathological progression of nephropathy in DN patients.