炎症指标在早期糖尿病肾病诊断和预防中的价值

Application of inflammatory indexes in diagnosis of early diabetic kidney disease

目的探讨炎症指标在早期糖尿病肾病(DKD)诊断和预防中的价值。方法选取2019年8月至2021年8月在丽水市人民医院确诊为2型糖尿病的300例患者为研究对象,其中单纯糖尿病、DKD微量蛋白尿(即早期DKD)和DKD大量蛋白尿,各100例。选取同期本院性别、年龄相互匹配的健康体检者50名作为健康对照组。收集各组一般资料,比较各组血清炎症指标和尿液指标的差异。采用多因素logistic回归分析早期DKD发生的危险因素。采用Spearman秩相关分析炎症指标和肾损伤相关指标的相关性。采用ROC曲线评估炎症指标对早期DKD的诊断效能。结果单纯糖尿病组、DKD微量蛋白尿组、DKD大量蛋白尿组患者CRP、TNF-α、IL-6水平均高于健康对照组,且DKD微量蛋白尿组、DKD大量蛋白尿组患者CRP、TNF-α、IL-6水平均高于单纯糖尿病组,差异均有统计学意义(均P<0.05),但DKD微量蛋白尿组、DKD大量蛋白尿组患者上述指标比较差异均无统计学意义(均P>0.05)。多因素logistic回归分析结果显示UNAG、β_(2)-MG、TG、CRP、IL-6是影响DKD发生的独立危险因素(均P<0.05),且CRP、IL-6与β_(2)-MG均呈正相关(均P<0.05)。ROC曲线显示CRP、IL-6、β_(2)-MG诊断早期DKD的AUC分别为0.714、0.769、0.785,而3项指标联合检测的AUC为0.862,高于各项指标单独检测。结论CRP、IL-6、β_(2)-MG联合检测在早期DKD诊断中具有较高的应用价值。

Objective To explore the value of inflammatory indexes in the diagnosis of early diabetes kidney disease(DKD).Methods Three hundred patients with type 2 diabetes(T2DM)diagnosed in Lishui People's Hospital from August 2019 to August 2021 were enrolled in the study,including 100 cases without DKD(simple DKD group),100 cases of DKD with microalbuminuria(early DKD group)and 100 cases of DKD massive albuminuria(severe DKD group);50 sex and age matched healthy subjects were selected as the control group.The serum inflammatory indexes and urine indexes were compared among groups.The risk factors of early DKD were analyzed with multivariate logistic regression;the association between inflammatory indexes and renal injury related indexes was examined with Spearman rank correlation;the diagnostic efficacy of inflammatory indexes for early DKD was evaluated with ROC curve.Results Serum CRP,TNF-αand IL-6 levels in DKD patients were significantly higher than those in the control group;the levels of above indicators in early and severe DKD groups were significantly higher than those in simple DKD group(all P<0.05),while there was no statistically significant difference between early and severe DKD groups(all P>0.05).Multivariate logistic regression analysis showed that urinary N acetylβ-D-glucosamine glycosidase andβ_(2)-microglobulin(β_(2)-MG),serum TG,CRP and IL 6 were independent risk factors of DKD(all P<0.05),and serum CRP,IL-6 were positively correlated with urinaryβ_(2)-MG(all P<0.05).The area under ROC curve(AUC)of CRP,IL-6,β_(2)-MG and the combination of three for diagnosis of early DKD was 0.714,0.769,0.785 and 0.862 respectively.Conclusion The combination of serum CRP,IL-6 and urinaryβ_(2)-MG levels has high application value in the early diagnosis of DKD.