联合检测血清sTNFR-1、KIM-1水平对2型糖尿病肾病的诊断能效

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摘要目的探究血清可溶性肿瘤坏死因子受体-1（sTNFR-1）、肾损伤分子-1（KIM-1）水平对2型糖尿病肾病（DN）的诊断价值。方法选取2016年1月—2019年1月在新疆维吾尔自治区喀什地区第一人民医院（以下简称“我院”）就诊的131例2型糖尿病患者为实验组，根据尿微量白蛋白/肌酐比值（ACR）水平将其分为三组：A1期组49例、A2期组44例、A3期组38例，同时选取我院同期体检的健康人员30名作为对照组。比较各组一般资料、临床实验室指标以及血清sTNFR-1、KIM-1的差异。采用受试者工作特征（ROC）曲线进行分析血清sTNFR-1、KIM-1对2型糖尿病肾病的诊断价值。结果实验组A1、A2、A3期年龄比较，差异有统计学意义（P ＜ 0.05），且A3期组年龄大于A2、A1期组，A2期组大于A1期组（P ＜ 0.05）。实验组空腹血糖（FBG）、sTNFR-1、KIM-1水平高于对照组，且随着DN分期的增加而逐渐上升，肾小球滤过率估值（eGFR）则逐渐下降，差异均有统计学意义（均P ＜ 0.05）。sTNFR-1、KIM-1分别与血肌酐（SCr）、尿微量白蛋白（UmAlb）、ACR呈正相关（r = 0.475、0.468、0.526， 0.713、0.693、0.714，均P ＜ 0.05），而与eGFR呈负相关（r = -0.569、-0.721、均P ＜ 0.05）。血清sTNFR-1、KIM-1联合诊断DN的诊断效能要优于单独血清sTNFR-1、KIM-1的诊断效能。结论 DN患者血清sTNFR-1、KIM-1水平显著升高，且与病情严重程度呈正相关，对糖尿病患者血清sTNFR-1、KIM-1的检测有助于DN患者的早期诊断、早期临床干预，进一步改善2型糖尿病患者的远期预后。

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	韩玉明罗胜芳万江丽

关键词 ： 2型糖尿病肾病, 可溶性肿瘤坏死因子受体-1, 肾损伤分子-1, 尿微量白蛋白/肌酐比值

Abstract：Objective To explore the diagnostic value of serum soluble tumor necrosis factor receptor-1 (sTNFR-1) and kidney injury molecule-1 (KIM-1) levels in type 2 diabetic nephropathy (DN). Methods From January 2016 to January 2019, a total of 131 patients with type 2 diabetes mellitus in the First People′s Hospital of Kashgar ( hereinafter referred to as “our hospital”) were selected as the experimental group. According to the urinary microalbumin/creatinine ratio (ACR) level, they were divided into three groups: A1 group (n = 49), A2 group (n = 44), A3 group (n = 38). And healthy people in the same period in our hospital were selected as the control group (n = 30). The differences in general information, clinical laboratory indicators and serum STNFR-1 and KIM-1 among the groups were compared. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of serum sTNFR-1 and KIM-1 in type 2 diabetic nephropathy. Results There was significant difference in age among A1, A2 and A3 stages in the experimental group (P ＜ 0.05), and the age of the A3 group was greater than that of the A2 and A1 groups, and the age of the A2 group was greater than that of the A1 group (P ＜ 0.05). The fasting blood-glucose (FBG), ACR, sTNFR-1 and KIM-1 levels in the experimental group were significantly higher than those of the control group, and gradually increased with the increase of stages of DN, while estimation of glomerular filtration rate (eGFR) decreased gradually (all P ＜ 0.05). sTNFR-1 and KIM-1 were positively correlated with serum creatinine (SCr), urine microalbumin (UmAlb), ACR (r = 0.475, 0.468, 0.526, 0.713, 0.693, 0.714, all P ＜ 0.05), but negatively correlated with eGFR (r = -0.569, -0.721, all P ＜ 0.05). The diagnostic efficacy of combination of serum sTNFR-1 and KIM-1 in the diagnosis of DN was better than that of serum sTNFR-1 and KIM-1 alone. Conclusion The serum levels of sTNFR-1 and KIM-1 in patients with DN are significantly increased and positively correlated with the severity of the disease. The detection of serum sTNFR-1 and KIM-1 in diabetic patients is helpful to the early diagnosis and early clinical intervention of DN patients and further improving the long-term prognosis of type 2 diabetic nephropathy.

Key words： Type 2 diabetic nephropathy Soluble tumor necrosis factor receptor-1 Kidney injury molecule-1 Urinary microalbumin/creatinine ratio

基金资助:新疆维吾尔自治区自然科学基金计划项目（2016D01C521）。

引用本文:

韩玉明罗胜芳万江丽. 联合检测血清sTNFR-1、KIM-1水平对2型糖尿病肾病的诊断能效[J]. 中国医药导报, 2020, 17(21): 78-81,87.
HAN Yuming LUO Shengfang WAN Jiangli. Diagnostic efficacy of combined detection of serum sTNFR-1 and KIM-1 levels in type 2 diabetic nephropathy. 中国医药导报, 2020, 17(21): 78-81,87.

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