2型糖尿病患者血清内皮型一氧化氮合酶、网膜素1水平预测糖尿病肾脏疾病发生的价值研究

Value of serum endothelial nitric oxide synthase and Omentin-1 levels for predicting the occurrence of diabetes nephropathy in type 2 diabetes patients

目的 分析2型糖尿病患者血清内皮型一氧化氮合酶(endothelial nitric oxide synthase,e NOS)、网膜素1(Omentin-1)水平对糖尿病肾脏疾病(diabetic kidney disease,DKD)发生的预测价值。方法 选取2020年5月至2023年2月石家庄市第二医院收治的2型DKD患者124例作为DKD组、单纯2型糖尿病患者125例作为对照组。收集所有患者的临床指标;酶联免疫吸附法检测患者血清eNOS、Omentin-1水平;Pearson法分析DKD患者血清eNOS、Omentin-1和临床指标的相关性;多因素Logistic回归模型分析影响2型糖尿病患者发生DKD的危险因素;受试者工作特征曲线分析2型糖尿病患者血清eNOS、Omentin-1水平对DKD发生的预测价值。结果 与对照组比较,DKD组患者血清总胆固醇[(4.75±0.91)mmol/L比(4.48±0.96)mmol/L]、糖化血红蛋白[(9.32±1.25)%比(8.56±1.23)%]、24 h尿蛋白定量[(2.78±0.31)g比(0.15±0.02)g]、尿微量白蛋白(urinary microalbumin,mAlb)[(273.12±20.41)mg/L比(23.08±3.35)mg/L]、血肌酐(serum creatinine,Scr)[(209.53±22.59)μmol/L比(73.52±9.21)μmol/L]水平显著升高,估算肾小球滤过率(estimatedglomerularfiltrationrate, eGFR)[(72.52±13.51)mL·min^(-1)·(1.73m^(2))^(-1)比(107.34±10.27)m L·min^(-1)·(1.73 m^(2))^(-1)]、血清e NOS[(24.48±3.37)U/L比(33.82±4.52)U/L]、Omentin-1[(28.75±4.42)μg/L比(43.63±6.78)μg/L]水平显著降低(P<0.05);DKD患者血清eNOS与Omentin-1水平呈正相关(r=0.674,P<0.05);血清eNOS、Omentin-1与24 h尿蛋白定量、m Alb、Scr呈负相关(r=-0.456、-0.551、-0.503、-0.527、-0.497、-0.495, P<0.05),与eGFR呈正相关(r=0.523、 0.602,P<0.05);24 h尿蛋白定量、mAlb、Scr是影响2型糖尿病患者发生DKD的危险因素(P<0.05),eGFR、e NOS、Omentin-1是影响2型糖尿病患者发生DKD的保护因素(P<0.05);血清eNOS、Omentin-1两者联合预测2型糖尿病患者发生DKD的曲线下面积(area under curve,AUC)为0.942,分别高于血清e NOS(AUC=0.882)、Omentin-1(AUC=0.862)各自单独预测2型糖尿病患者发生DKD的AUC(P<0.05)。结论 DKD患者血清eNOS与Omentin-1水平均呈低表达,二者联合检测对2型糖尿病患者发生DKD有一定预测价值。

Objective To explore the predictive value of serum levels of endothelial nitric oxide synthase(eNOS)and Omentin^(-1) for the occurrence of diabetic kidney disease(DKD)in type 2 diabetes mellitus(T2DM)patients.Methods From May 2020 to February 2023,124 hospitalized patients with type 2 DKD were selected as DKD group and 125 patients with simple type 2 diabetes as control group.Clinical parameters of all patients were collected.Serum levels of eNOS and Omentin^(-1) were detected by enzyme-linked immunosorbent assay(ELISA).Pearson’s method was utilized for examin-ing the correlation between serum eNOS,Omentin^(-1) and clinical parameters.Multivariate Logistic re-gression model was employed for examining the risk factors of DKD occurrence in T2DM.The predic-tive value of serum levels of eNOS and Omentin^(-1) for the occurrence of DKD was examined by re-ceiver operating characteristic(ROC)curve.Results As compared with control group,serum levels of total cholesterol[(4.75±0.91)mmol/L vs(4.48±0.96)mmol/L],glycosylated hemoglobin[(9.32±1.25)%vs(8.56±1.23)%],24 h urinary protein quantity[(2.78±0.31)g vs(0.15±0.02)g],urinary microalbumin(mAlb)[(273.12±20.41)mg/L vs(23.08±3.35)mg/L]and serum creatinine(Scr)[(209.53±22.59)μmol/L vs(73.52±9.21)μmol/L]spiked markedly in DKD group.And the levels of estimated glomerular filtration rate(eGFR)[(72.52±13.51)mL·min^(-1)·(1.73 m^(2))^(-1) vs(107.34±10.27)mL·min^(-1)·(1.73 m^(2))^(-1)],serum eNOS[(24.48±3.37)U/L vs(33.82±4.52)U/L]and Omentin^(-1)[(28.75±4.42)μg/L vs(43.63±6.78)μg/L]rose sharply(P<0.05).A positive correlation existed between serum eNOS and Omentin^(-1) level(r=0.674,P<0.05).Serum levels of eNOS and Omentin^(-1) were correlated negatively with 24 h urinary protein quan-tity,mAlb and Scr(r=-0.456,-0.551,-0.503,-0.527,-0.497,-0.495,P<0.05)and yet positively with eGFR(r=0.523,0.602,P<0.05).24 h urinary protein quantity,mAlb and Scr were risk factors for DKD oc-currence in T2DM(P<0.05)while eGFR,eNOS and Omentin^(-1) were protective factors for DKD occur-rence in T2DM(P<0.05).The area under curve(AUC)of serum eNOS plus Omentin^(-1) in predicting DKD occurrence in T2DM was 0.942.It was higher than that of serum eNOS(AUC=0.882)and Omentin^(-1)(AUC=0.862)separately predicting DKD occurrence in T2DM patients(P<0.05).Conclusions Serum levels of eNOS and Omentin^(-1) are both low and a combined detection of both has some predictive values for the occurrence of DKD in T2DM patients.