老年糖尿病肾病患者血清鸢尾素和metrnl水平与糖脂代谢和炎症反应的相关性分析

Correlation of levels of serum irisin and metrnl with glycolipid metabolism and inflammatory reaction in elderly patients with diabetic nephropathy

目的探讨老年糖尿病肾病患者血清鸢尾素(irisin)和镍纹样蛋白(metrnl)水平与糖脂代谢和炎症反应的关系。方法抽取2022年1月至2023年4月郑州大学第一附属医院老年内分泌科收治的70例糖尿病肾病患者作为糖尿病肾病组,70例单纯糖尿病患者作为糖尿病组,另抽取同期行健康体检的70例健康体检者作为对照组。收集并比较三组观察对象的irisin、metrnl水平,糖脂代谢指标[空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]及炎症指标[超敏C反应蛋白(hs-CRP),白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平,分析irisin、metrnl水平与糖脂代谢指标及炎症指标的相关性,同时分析血清irisin、metrnl对糖尿病肾病的诊断价值。结果糖尿病组和糖尿病肾病组FPG、FINS、HbA1c、TG、hs-CRP、IL-6、TNF-α水平高于对照组(P<0.05),irisin、metrnl低于对照组(P<0.05);糖尿病肾病组FPG、FINS、HbA1c、TG、hs-CRP、IL-6、TNF-α水平高于糖尿病组(P<0.05),血清irisin、metrnl水平低于糖尿病组(P<0.05)。血清irisin与FPG、FINS、HbA1c、TG、IL-6、TNF-α水平呈负相关(P<0.05),与metrnl呈正相关(P<0.05);血清metrnl与FPG、FINS、HbA1c、TG、IL-6、TNF-α水平呈负相关(P<0.05)。血清irisin、metrnl单独及两者联合诊断糖尿病肾病的受试者工作特征曲线的曲线下面积分别为0.787、0.794、0.818,灵敏度分别为69.54%、78.27%、85.23%,特异度分别为72.25%、74.12%、76.57%,约登指数分别为0.418、0.524、0.618。结论老年糖尿病肾病患者血清irisin和metrnl降低,irisin和metrnl水平与糖脂代谢及炎症反应关系密切,在老年糖尿病肾病的诊断中具有一定价值。

Objective To investigate the levels of serum irisin and meteorin-like protein(metrnl)with glycolipid metabolism and inflammatory reaction in elderly patients with diabetic nephropathy.Methods A total of 70 patients with diabetic nephropathy admitted to the First Affiliated Hospital of Zhengzhou University from January 2022 to April 2023 were selected as the diabetic nephropathy group,another 70 patients only with diabetes mellitus were selected as diabetes group,and 70 healthy people who underwent physical examination during the same period were selected as control group.The levels of irisin,metrnl,lipid metabolism indicators,including fasting plasma glucose(FPG),fasting insulin(FINS),hemoglobin A1c(HbA1c),triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C),and inflammation indicators,including high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),of the three groups were collected and compared.The correlation of levels of irisin and metrnl with glycolipid metabolism indicators and inflammation indicators was analyzed,meanwhile,the diagnostic value of serum irisin and metrnl for diabetic nephropathy were analyzed.Results The levels of FPG,FINS,HbA1c,TG,hs-CRP,IL-6 and TNF-αin the diabetes group and diabetic nephropathy group were higher than those in the control group(P<0.05),while the levels of serum irisin and metrnl were lower than those in the control group(P<0.05).The levels of FPG,FINS,HbA1c,TG,hs-CRP,IL-6 and TNF-αin the diabetic nephropathy group were higher than those in the diabetes group(P<0.05),while the levels of serum irisin and metrnl were lower than those in the diabetes group(P<0.05).The serum irisin level was negatively correlated with levels of FPG,FINS,HbA1c,TG,IL-6 and TNF-α(P<0.05),and it had a positive correlation with metrnl(P<0.05).The serum metrnl level was negatively correlated with levels of FPG,FINS,HbA1c,TG,IL-6 and TNF-α(P<0.05).The areas under the receiver operating characteristic curve of serum irisin,metrnl and their combination in the diagnosis of diabetic nephropathy were 0.787,0.794 and 0.818,respectively,the sensitivity of them were 69.54%,78.27%,85.23%,respectively,the specificity of them were 72.25%,74.12%and 76.57%,respectively,the Jordan index of them were 0.418,0.524 and 0.618,respectively.Conclusions The levels of serum irisin and metrnl in elderly patients with diabetic nephropathy decrease,while the levels of irisin and metrnl are closely related to glycolipid metabolism and inflammatory reaction,which have certain value in the diagnosis of diabetic nephropathy in elderly patients.