新诊断2型糖尿病患者血清糖萼脱落标志物水平对早期肾脏损伤的诊断价值

The diagnostic value of serum glycocalyx injury markers in newly diagnosed type 2 diabetes patients for early renal damage

目的探讨新诊断T2DM患者血清糖萼脱落(GS)标志物水平对早期肾脏损伤的诊断价值。方法选取2018年10月至2022年2月于无锡市第二人民医院内分泌与代谢病科治疗的新诊断T2DM患者218例,根据UACR水平分为无白蛋白尿组(NAU,n=113)及微量白蛋白尿组(MAU,n=105),比较两组一般资料与生化指标,分析GS与肾脏损伤的相关性。结果Spearman相关分析显示,UACR与BUN、尿液α1-微球蛋白(α1-MG)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、多配体蛋白聚糖1(Sdc-1)及透明质酸(HA)呈正相关(P<0.01),与eGFR呈负相关(P<0.05);血清Sdc-1与UACR、α1-MG、NGAL及HA呈正相关(P<0.01),与HbA1c呈负相关(P<0.05);血清HA与UACR、α1-MG、NGAL及Sdc-1呈正相关(P<0.01)。多元逐步回归分析显示,NGAL、Sdc-1、α1-MG及RBP是UACR的影响因素。受试者工作特征(ROC)曲线分析显示,Sdc-1、HA、联合诊断肾脏损伤的ROC曲线下面积为0.857、0.812、0.931。结论GS增加MAU发生风险,检测GS标志物有助于评估新诊断T2DM早期肾脏损伤。

Objective To exploring the diagnostic value of serum glycocalyx shedding(GS)marker for early renal injury in patients with newly diagnosed type 2 diabetes mellitus(T2DM).Methods 218 newly diagnosed T2DM patients who were treated in the Department of Endocrinology and Metabolism of Wuxi Second People's Hospital from October 2018 to February 2022 were selected.According to the level of UACR,they were divided into the group without albuminuria(NAU,n=113)and the group with microalbuminuria(MAU,n=105).The general data and biochemical indicators of the two groups were compared.The correlation between GS and renal injury was analyzed.Results Spearman correlation analysis showed that UACR were positively correlated with BUN,urine al-microglobulin(al-MG),neutrophil gelatinase related lipid transporter(NGAL),multi ligand proteoglycan 1(Sdc-1)and hyaluronic acid(HA)(P<0.01),and negatively correlated with eGFR(P<0.05).Serum Sdc-1 were positively correlated with UACRαl-MG,NGAL and HA(P<0.01),and negatively correlated with HbAic(P<0.05).Serum HA showed a positive correlation with UACR al-MG,NGAL and Sdc-1(P<0.01).Multiple stepwise regression analysis showed that NGAL,Sdc-1α1-MG and RBP were the influencing factors of UACR.The analysis of the receiver operating characteristic(ROC)curve showed that the area under ROC curve for Sdc-1,HA,and Sdc-1 combined HA on the diagnosis of renal injury was 0.857,0.812 and 0.931,respectively.Conclusion GS increases the risk of MAU.Detection of GS biomarkers is beneficial for the early diagnosis of kidney injury in newly diagnosed T2DM patients.