血清SFRP-4在2型糖尿病肾病患者不同病理阶段的表达水平及对预后的预测价值

Expression level of serum SFRP-4 in different pathological stages of patients with type 2 diabetes kidney disease and its prognostic value

目的探究血清分泌型卷曲相关蛋白-4(SFRP-4)在2型糖尿病肾病(T2DKD)患者中不同病理阶段的表达水平及对预后的预测价值。方法选择2020年1月至2022年1月于该院就诊的140例T2DKD患者为T2DKD组,140例单纯2型糖尿病(T2DM)患者为T2DM组,另选择同期于该院体检的140例健康者为对照组。对比3组的一般资料和生化指标,并比较不同肾损伤程度T2DKD患者的一般资料及生化指标。依据预后情况,将140例T2DKD患者分为预后良好组(n=87)和预后不良组(n=53),通过单因素和多因素Logistic分析T2DKD患者预后不良的独立危险因素。应用Logistic回归模型结合限制性立方样条模型(RCS)分析T2DKD患者的SFRP-4表达水平与T2DKD患者预后不良的剂量-反应关系。依据独立因素构建列线图预测模型,并对模型进行验证。结果随着肾损伤程度的增加,T2DKD患者T2DM病程、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、肌酐(Scr)、尿素氮(BUN)、尿酸(UA)、尿β2-微球蛋白(β2-MG)和SFRP-4逐渐增高(P<0.05),白蛋白(Alb)逐渐降低(P<0.05)。FPG、Scr、BUN、尿β2-MG和SFRP-4是T2DKD患者预后不良的独立危险因素(P<0.05)。RCS结果显示,SFRP-4与T2DKD患者预后不良呈非线性剂量-反应关系,随着SFRP-4表达水平的增高,T2DKD患者预后不良的风险逐渐升高。利用独立危险因素构建列线图预测模型,模型具有良好的区分度和准确性。结论随着肾损伤程度的增加,T2DKD患者的SFRP-4表达水平逐渐增高。SFRP-4是T2DKD患者预后的独立危险因素,与患者预后不良呈非线性剂量-反应关系,随着SFRP-4表达水平的增高,T2DKD患者预后不良的风险逐渐上升。

Objective To explore the expression level of serum recombinant secreted frizzled related protein 4(SFRP-4)in different pathological stages of patients with type 2 diabetes kidney disease(T2DKD)and its prognostic value.Methods A total of 140 patients with T2DKD who visited the hospital from January 2020 to January 2022 were selected as T2DKD group,and 140 patients with type 2 diabetes mellitus(T2DM)who visited the hospital in the same period were selected as T2DM group and 140 healthy people who underwent physical examination in the hospital in the same period were selected as control group.The general data and biochemical indicators of the three groups were compared,and the general data and biochemical indicators of T2DKD patients with different degrees of renal injury were compared.According to the prognosis,140 patients with T2DKD were divided into the good prognosis group(n=87)and the poor prognosis group(n=53).The independent risk factors for poor prognosis of T2DKD patients were analyzed by single factor and multivariate Logistic analysis.The dose-response relationship between SFRP-4 expression level and the poor prognosis of T2DKD patients was analyzed by using Logistic regression model and restricted cubic splines(RCS).The nomograph prediction model was built based on independent factors and verified.Results With the increase of the degree of renal injury,the course of T2DM,fasting plasma glucose(FPG),glycated hemoglobin(HbA1c),creatinine(Scr),urea nitrogen(BUN),uric acid(UA),urineβ2-microglobulin(β2-MG)and SFRP-4 in T2DKD patients gradually increased(P<0.05),while albumin(Alb)gradually decreased(P<0.05).FPG,Scr,BUN,urineβ2-MG and SFRP-4 were independent risk factors for poor prognosis in T2DKD patients(P<0.05).RCS results showed that SFRP-4 had a non-linear dose-response relationship with poor prognosis of T2DKD patients.With the increase of SFRP-4 expression level,the risk of poor prognosis of T2DKD patients increased gradually.The nomograph prediction model was constructed by using independent risk factors,and the model had good discrimination and accuracy.Conclusion With the increase of the degree of renal injury,the expression level of SFRP-4 in T2DKD patients gradually increased.SFRP-4 is an independent risk factor for poor prognosis in T2DKD patients,and has a non-linear dose-response relationship with poor prognosis.With the increase of SFRP-4 expression level,the risk of poor prognosis of T2DKD patients increases gradually.