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

刘丹枫; 王军芬; 范国洽; 何金花; 周亚茹

doi:10.3969/j.issn.1671-2390.2024.04.005

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

摘要

摘要:
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，eNOS）、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（estimated glomerular filtration rate，eGFR）（72.52 ± 13.51）mL·min⁻¹·（1.73 m²）⁻¹比（107.34 ± 10.27）mL·min⁻¹·（1.73 m²）⁻¹、血清eNOS（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、mAlb、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、eNOS、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eNOS（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。

Abstract:
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 examining the correlation between serum eNOS, Omentin-1 and clinical parameters. Multivariate Logistic regression model was employed for examining the risk factors of DKD occurrence in T2DM. The predictive value of serum levels of eNOS and Omentin-1 for the occurrence of DKD was examined by receiver 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 m²)⁻¹ vs (107.34±10.27) mL·min⁻¹·(1.73 m²)⁻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 quantity, 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 occurrence in T2DM (P<0.05) while eGFR, eNOS and Omentin-1 were protective factors for DKD occurrence 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.

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