血清Fetuin-A联合FABP4预测2型糖尿病患者肾病发病风险的价值

Value of serum Fetuin-A and FABP4 in prediction of nephropathy risk in patients with type 2 diabetes mellitus

目的探讨血清血清胎球蛋白A(Fetuin-A)联合脂肪酸结合蛋白4(fatty acid binding protein 4,FABP4)预测2型糖尿病患者糖尿病肾病发病风险的价值。方法选取2021年8月至2023年7月西安工会医院收治的2型糖尿病患者107例,男55例,女52例,年龄(61.69±9.05)岁。根据尿白蛋白/肌酐比值将患者分为正常白蛋白尿组48例、微量白蛋白尿组39例、大量白蛋白尿组20例。选择50例健康体检者作为健康对照组,男26例,女24例,年龄(60.87±8.24)岁。比较各组基本资料、FABP4、Fetuin-A、C反应蛋白(C-reactive protein,CRP)、脂联素水平和血脂血糖相关指标水平。采用方差分析、LSD-t检验、χ^(2)检验。结果正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组患者体质量指数(body mass index,BMI)分别为(24.35±3.04)kg/m^(2)、(25.06±3.12)kg/m^(2)、(24.88±2.83)kg/m^(2),均高于健康对照组的(22.48±2.83)kg/m^(2)(均P<0.05);正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组患者血清FABP4水平分别为(7.92±1.76)μg/L、(8.46±1.98)μg/L、(9.23±2.05)μg/L,Fetuin-A水平分别为(330.67±44.32)mg/L、(385.38±49.15)mg/L、(413.10±56.28)mg/L,CRP水平分别为(4.77±1.34)mg/L、(5.83±1.96)mg/L、(6.59±2.17)mg/L,均高于健康对照组的(6.77±1.32)μg/L、(224.56±31.93)mg/L、(2.36±1.11)mg/L(均P<0.05),脂联素水平分别为(7.56±2.31)mg/L、(5.21±2.09)mg/L、(4.33±1.95)mg/L,低于健康对照组的(11.12±2.43)mg/L(均P<0.05);正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组患者空腹血糖(fasting blood glucose,FBG)分别为(8.23±2.79)mmol/L、(8.48±3.18)mmol/L、(8.51±3.26)mmol/L,糖化血红蛋白(glycosylated hemoglobin,type A1C,HbA1c)分别为(8.79±1.35)%、(8.96±1.47)%、(9.04±1.52)%,低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)分别为(3.35±0.71)mmol/L、(3.26±0.72)mmol/L、(3.51±0.77)mmol/L,总胆固醇(total cholesterol,TC)分别为(5.15±0.97)mmol/L、(5.08±0.95)mmol/L、(5.18±0.97)mmol/L,三酰甘油(triacylglycerol,TG)水平分别为(1.69±0.73)mmol/L、(1.82±0.85)mmol/L、(1.84±0.79)mmol/L,均高于健康对照组的(4.52±0.67)mmol/L、(5.18±1.03)%、(2.28±0.57)mmol/L、(4.52±0.85)mmol/L、(1.24±0.42)mmol/L(均P<0.05),高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)水平分别为(1.12±0.47)mmol/L、(1.15±0.50)mmol/L、(1.17±0.48)mmol/L,低于健康对照组的(1.36±0.28)mmol/L(P=0.030);正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组患者餐后2 h血糖差异无统计学意义(P>0.05);2型糖尿病患者肾病发病风险随着血清Fetuin-A、FABP4水平升高而增加(均P<0.05);血清Fetuin-A联合FABP4预测2型糖尿病患者肾病发病风险的曲线下面积(AUC)为0.873(95%CI 0.782~0.963,P<0.001),灵敏度85.17%,特异度84.44%。结论血清Fetuin-A联合FABP4预测2型糖尿病患者肾病发病风险有较高的特异度和灵敏度,具有一定预测价值。

Objective To investigate the value of serum Fetuin-A and fatty acid binding protein 4(FABP4)in the prediction of nephropathy risk in patients with type 2 diabetes mellitus.Methods A total of 107 patients with type 2 diabetes mellitus admitted to Xi'an Trade Union Hospital from August 2021 to July 2023 were selected,including 55 males and 52 females who were(61.69±9.05)years old;they were divided into a normal albuminuria group(48 cases),a microalbuminuria group(39 cases),and a macroalbuminuria group(20 cases)according to their urinary albuminuria/creatinine ratios.Fifty healthy examinees were selected as a healthy control group,including 26 males and 24 females who were(60.87±8.24)years old.The basic data and levels of FABP4,Fetuin-A,C-reactive protein(CRP),adiponectin,and blood lipids and glucose related indicators were compared.Analysis of variance,LSD-t test,and χ^(2) test were applied.Results The body mass indexes(BMI)of the normal albuminuria group,the microalbuminuria group,and the macroalbuminuria group were(24.35±3.04)kg/m^(2),(25.06±3.12)kg/m^(2),and(24.88±2.83)kg/m^(2),which were higher than that in the healthy control group[(22.48±2.83)kg/m2](all P<0.05).The levels of FABP4,Fetuin-A,and CRP of the normal albuminuria group,the microalbuminuria group,and the macroalbuminuria group were(7.92±1.76)μg/L,(8.46±1.98)μg/L,and(9.23±2.05)μg/L,(330.67±44.32)mg/L,(385.38±49.15)mg/L,and(413.10±56.28)mg/L,and(4.77±1.34)mg/L,(5.83±1.96)mg/L,and(6.59±2.17)mg/L,respectively,which were higher than those in the healthy control group[(6.77±1.32)μg/L,(224.56±31.93)mg/L,and(2.36±1.11)mg/L](all P<0.05);the levels of adiponectin of the normal albuminuria group,the microalbuminuria group,and the macroalbuminuria group were(7.56±2.31)mg/L,(5.21±2.09)mg/L,and(4.33±1.95)mg/L,respectively,which were lower than that in the healthy control group[(11.12±2.43)mg/L](all P<0.05).The levels of fasting blood glucose(FBG),glycosylated hemoglobin,type A1C(HbA1c),low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),and triacylglycerol(TG)of the normal albuminuria group,the microalbuminuria group,and the macroalbuminuria group were(8.23±2.79)mmol/L,(8.48±3.18)mmol/L,and(8.51±3.26)mmol/L,(8.79±1.35)%,(8.96±1.47)%,and(9.04±1.52)%,(3.35±0.71)mmol/L,(3.26±0.72)mmol/L,and(3.51±0.77)mmol/L,(5.15±0.97)mmol/L,(5.08±0.95)mmol/L,and(5.18±0.97)mmol/L,and(1.69±0.73)mmol/L,(1.82±0.85)mmol/L,and(1.84±0.79)mmol/L,respectively,which were higher than those in the healthy control group[(4.52±0.67)mmol/L,(5.18±1.03)%,(2.28±0.57)mmol/L,(4.52±0.85)mmol/L,and(1.24±0.42)mmol/L](P<0.001,P<0.001,P<0.001,P=0.003,and P<0.001);the levels of high density lipoprotein cholesterol(HDL-C)of the normal albuminuria group,the microalbuminuria group,and themacroalbuminuriagroupwere(1.12±0.47)mmol/L,(1.15±0.50)mmol/L,and(1.17±0.48)mmol/L,respectively,which were lower than that in the healthy control group[(1.36±0.28)mmol/L](P=0.030).There was no statistical difference in 2 h postprandial blood glucose between the normal albuminuria group,the microalbuminuria group,and the macroalbuminuria group(P>0.05).The nephropathy risk in the patients increased with the serum levels of Fetuin-A and FABP4(both P<0.001).The area under the curve(AUC)of Fetuin-A combined with FABP4 in the prediction of nephropathy in the patients was 0.873(95%CI 0.782-0.963,P<0.001);the sensitivity was 85.17%;specificity was 84.44%.Conclusion Serum Fetuin-A combined with FABP4 has high specificity and sensitivity in predicting the nephropathy risk in patients with type 2 diabetes mellitus,and has certain predictive value.