血清Vaspin、cathelicidin的表达对糖尿病患儿早期肾功能改变的预测价值

Predictive Value of Serum Vaspin and Cathelicidin Expression for Early Renal Function Changes in Children with Diabetes

目的探讨血清腹腔脂肪型丝氨酸蛋白酶抑制剂(Vaspin)、抗菌肽cathelicidin(LL-37)的表达对糖尿病患儿早期肾功能改变的预测价值。方法选取2020年7月—2023年7月遵义市第一人民医院收治的80例糖尿病住院患儿作为研究对象,依照患儿尿蛋白水平进行分组,分为正常组(尿蛋白<30 g/g Cr,n=31),微量组(尿蛋白为30~300 g/g Cr,n=24),大量组(尿蛋白>300 g/g Cr,n=25)。对比三组患儿血清Vaspin、cathelicidin表达水平,对比三组患儿尿酸(UA)、尿素氮(BUN)、血肌酐(Scr)、胱抑素C(CysC)常规肾功能损伤指标,分析血清Vaspin、cathelicidin与UA、BUN、Scr、CysC水平的相关性,并建立受试者特征(ROC)工作曲线分析Vaspin、cathelicidin诊断糖尿病患儿早期肾功能改变的临界值与诊断效能。结果三组患儿Vaspin、cathelicidin表达水平对比,大量组Vaspin水平明显高于微量组和正常组,cathelicidin水平明显低于微量组和正常组(P<0.05);三组患儿UA、BUN、Scr、CysC表达水平对比,大量组UA、BUN、Scr、CysC水平明显高于微量组和正常组(P<0.05),但微量组与正常组对比,差异无统计学意义(P>0.05);Spearman相关分析结果显示:UA、BUN、Scr、CysC与Vaspin呈正相关,UA、BUN、Scr、CysC与cathelicidin呈负相关(P<0.05);Vaspin临界值取7.97 ng/mL时,诊断指数达到最大值1.695,对糖尿病患儿早期肾功能改变的灵敏度为85.37%,特异性为82.73%。cathelicidin临界值取22.14μg/L时,诊断指数达到最大值1.654,对糖尿病患儿早期肾功能改变的灵敏度为84.84%,特异性为80.73%。当Vaspin临界值取7.97 ng/mL,cathelicidin临界值取22.14μg/L时,诊断指数达到最大值1.731,联合诊断糖尿病患儿早期肾功能改变的灵敏度为93.15%,特异性为88.34%,高于单一诊断。结论Vaspin联合cathelicidin检测可提升糖尿病患儿早期肾功能改变的诊断效能,Vaspin>7.97 ng/mL,cathelicidin<22.14μg/L时要警惕早期肾功能改变的发生,并及时采取相关措施进行干预。但由于Vaspin、cathelicidin水平可能与糖尿病所引起的心脏、血管、胃肠等多器官损伤相关,因此Vaspin、cathelicidin是否可作为糖尿病患儿早期肾功能改变的独立预测指标还有待深入研究分析。

Objective To explore the predictive value of the expression of serum abdominal fat Serpin(Vaspin)and Cathelicidin cathelicidin(LL-37)on the early changes of renal function in children with diabetes.Methods Eighty hospitalized children with diabetes admitted to the First People's Hospital of Zunyi City from July 2020 to July 2023 were selected as the study subjects.They were divided into normal group(urinary protein<30 g/g Cr,n=31),micro group(urinary protein 30~300 g/g Cr,n=24),and large group(urinary protein>300 g/g Cr,n=25)according to their urinary protein level.Compare the expression levels of serum Vaspin and cathelicin in three groups of children,compare the routine renal function injury indicators of uric acid(UA),urea nitrogen(BUN),blood creatinine(Scr),and cystatin C(CysC)in three groups of children,analyze the correlation between serum Vaspin and cathelicin with UA,BUN,Scr,and CysC levels,and establish a subject characteristic(ROC)working curve to analyze Vaspin The critical value and diagnostic effi cacy of cathelicidin in the diagnosis of early renal function changes in children with diabetes.Results There were signifi cant diff erences in the expression levels of Vaspin and cathelicin among the three groups of children.Vaspin levels in a large number of groups were signifi cantly higher than those in the trace group and normal group,while cathelicin levels were signifi cantly lower than those in the trace group and normal group(P<0.05);There were significant differences in the expression levels of UA,BUN,Scr,and CysC among the three groups of children.The levels of UA,BUN,Scr,and CysC in a large number of groups were signifi cantly higher than those in the trace group and the normal group(P<0.05),but there was no signifi cant diff erence between the trace group and the normal group(P>0.05);Spearman correlation analysis showed that UA,BUN,Scr,CysC were positively correlated with Vaspin,while UA,BUN,Scr,CysC were negatively correlated with cathelicin(P<0.05);When the critical value of Vaspin was 7.97 ng/mL,the diagnostic index reached the maximum value of 1.695,and the sensitivity and specifi city of early renal function changes in children with diabetes were 85.37%and 82.73%respectively.The critical value of catalicidin is set to 22.14μg/L,the diagnostic index reached the maximum value of 1.654,and the sensitivity and specifi city of early renal function changes in children with diabetes were 84.84%and 80.73%respectively.When the critical value of Vaspin is 7.97 ng/mL and the critical value of catalicidin is 22.14μg/L,the diagnostic index reached the maximum value of 1.731.The sensitivity of combined diagnosis of early renal function changes in children with diabetes was 93.15%,and the specifi city was 88.34%,higher than that of single diagnosis.Conclusion Vaspin combined with cathelicidin can improve the diagnostic efficacy of early renal function changes in children with diabetes.For Vaspin>7.97 ng/mL,cathelicidin<22.14μg/L and take relevant measures for intervention in a timely manner.However,since the levels of Vaspin and cathelicidin may be related to the damage of heart,blood vessels,gastrointestinal and other multiple organs caused by diabetes,whether Vaspin and cathelicidin can be used as independent predictors of early renal function changes in children with diabetes needs further research and analysis.