炎性指标与免疫学指标在糖尿病患者肾脏病变诊断与预后判断中的价值

Value of inflammatory markers and immune index in diagnosis and prognosis of diabetic patients with renal diseases

摘要:

目的  研究炎性指标与免疫学指标在糖尿病患者肾脏病变诊断与预后判断中的临床价值。方法  选取河北医科大学第二医院2010年3月-2014年6月收治的108例糖尿病患者作为研究对象，分为糖尿病组（A组）和糖尿病肾病组（B组），糖尿病肾病组又分为预后较好组（C组）和预后不良组（D组）。对各组患者的炎性指标和免疫指标进行测定。结果  B组患者糖化血红蛋白测定（HbAlc）、三酰甘油（TC）、总胆固醇（TG）和低密度脂蛋白（LDL-C）水平均较A组明显偏高（P <0.05）；D组患者HbAlc、TC、TG和LDL-C水平均较C组明显偏高（P <0.05）；A组患者自然杀伤细胞（NK）细胞水平显著高于B组（t =2.620，P =0.010）；B组患者免疫球蛋白A（IgA）、免疫球蛋白M（IgM）水平显著高于A组（P <0.05）；C组患者CD4、NK细胞水平显著高于D组患者（P <0.05）；C组患者CD8、IgA和IgM水平显著低于D组患者（P <0.05）；B组患者超敏C反应蛋白（hs-CRP）、肿瘤坏死因子（TNF-α）、白细胞介素1（IL-1）水平显著高于A组（P <0.05）；B组患者IL-6水平显著低于A组（t =5.425，P =0.000）；D组患者hs-CRP、TNF-α、IL-1水平显著高于C组（P <0.05）；B组患者IL-6水平与A组差异无统计学意义（t =0.783，P =0.483）。结论  监测体内免疫指标NK细胞，IgA、IgM和炎性指标hs-CRP、IL-1、-IL-6和TNF-α水平对于糖尿病肾病的早期诊断和判断预后均有积极意义。

Abstract:

Objective To study the clinical value of inflammatory and immunological indexes in diagnosis and prognosis of diabetic patients with renal diseases. Methods From March 2010 to June 2014, 108 cases of diabetic patients treated in our hospital were divided into diabetic group (group A) and diabetic combined nephropathy group (group B). According to the renal fuction, patients in group B were divided into good prognosis group (group C) and poor prognosis group (group D). The inflammatory and immune indexes of all patients were measured. Results The levels of TG, TC, HbAlc and LDL-C in group A were significantly higher than those in group B (P < 0.05). The levels of TG, TC, HbAlc and LDL-C in group C were significantly higher than those in group D (P < 0.05). The level of NK cells in the patients of group A was significantly higher than that in group B (t = 2.620, P = 0.010). The levels of IgM and IgA in patients of group B were significantly higher than those in group A (P < 0.05). The levels of CD4＋ and NK cells in patients of group C were significantly higher than those in group D (P < 0.05). The levels of IgA and CD8＋ in group C were significantly lower than those in group D (P < 0.05). The levels of IL-1, TNF and hs-CRP in group B were significantly higher than that in group A (P < 0.05), and the level of IL-6 in group B was significantly lower than that in group A (t = 5.425, P = 0.000). The levels of IL-1, TNF- and hs-CRP in group D were significantly higher than that in group C (P < 0.05), and there was no significant difference of IL-6 between group A and B (t = 0.783, P = 0.483). Conclusions The immunological indexes including NK cells, IgM, hs-CRP, and inflammatory indexes including IgA, -IL-6, IL-1 and TNF- levels have clinical value on early diagnosis and evaluation of prognosis of diabetic nephropathy.