糖尿病合并特发性膜性肾病患者血清MCP-1、MMP-9水平变化及其临床意义

Changes and clinical significance of serum MCP-1 and MMP-9 levels in diabetic patients with idiopathic membranous nephropathy

摘要:

目的 探讨糖尿病合并特发性膜性肾病（IMN）患者血清单核细胞趋化蛋白1（MCP-1）、基质金属蛋白酶9（MMP-9）的变化及其临床意义。方法 选取2018年5月—2021年7月连云港市中医院收治的糖尿病合并IMN患者123例作为研究对象（研究组）；另选取同期在该院体检的单纯糖尿病患者75例为对照组。收集所有患者基本资料，分析影响糖尿病患者发生IMN的因素，探究血清MCP-1、MMP-9诊断糖尿病合并IMN的价值，统计研究组不同肾间质纤维化肾小管萎缩（IFTA）病变程度患者血清MCP-1、MMP-9水平。结果 多因素Logistic回归分析结果显示：尿蛋白/肌酐比值［O^R=3.511（95% CI：1.445，8.534）］、估算肾小球滤过率［O^R=3.725（95% CI：1.533，9.052）］、MCP-1［O^R=3.184（95% CI：1.310，7.737）］、MMP-9［O^R=2.986（95% CI：1.229，7.257）］是影响糖尿病患者发生IMN的危险因素（P <0.05）。ROC曲线结果显示，MCP-1、MMP-9及两者联合诊断糖尿病患者发生IMN的敏感性分别为70.73%（95% CI：0.174，0.383）、73.98%（95% CI：0.141，0.341）和70.73%（95% CI：0.042，0.189），特异性分别为73.33%（95% CI：0.216，0.383）、77.33%（95% CI：0.187，0.348）和90.67%（95% CI：0.216，0.383），AUC分别为0.755（95% CI：0.656，0.853）、0.774（95% CI：0.677，0.871）和0.898（95% CI：0.835，0.962），两者联合诊断糖尿病患者发生IMN的特异性、AUC最大。IFTA重度病变组血清MCP-1、MMP-9水平高于中度病变组、轻度病变组（P <0.05），IFTA中度病变组血清MCP-1、MMP-9水平高于轻度病变组（P <0.05）。结论 血清MCP-1、MMP-9水平与糖尿病患者发生IMN有关，MCP-1联合MMP-9诊断糖尿病合并IMN效能良好，MCP-1、MMP-9可能与IFTA病变有关。

Abstract:

Objective To explore the changes and clinical significance of serum monocyte chemoattractant protein 1 (MCP-1) and matrix metalloproteinase 9 (MMP-9) levels in patients with diabetes mellitus complicated with idiopathic membranous nephropathy (IMN).Methods A total of 123 patients with diabetes mellitus and IMN admitted to Lianyungang Hospital of Traditional Chinese Medicine from May 2018 to July 2021 were selected and set as the study group. Meanwhile, 75 patients with merely diabetes mellitus who underwent physical examination in the hospital during the same time period were selected as the control group. The clinical data of all patients were collected, and factors affecting the occurrence of IMN in diabetic patients were analyzed. The value of serum MCP-1 and MMP-9 in diagnosing IMN in diabetic patients was explored. In addition, the serum MCP-1 and MMP-9 levels of patients with different degrees of interstitial fibrosis and tubular atrophy (IFTA) in the study group were determined.Results Multivariable Logistic regression analysis showed that urine protein to creatinine ratio [O^R = 3.511 (95% CI: 1.445, 8.534) ], estimated glomerular filtration rate [O^R = 3.725 (95% CI: 1.533, 9.052)], MCP-1 [O^R = 3.184 (95% CI: 1.310, 7.737)] and MMP-9 [O^R = 2.986 (95% CI: 1.229, 7.257) ] levels were factors affecting the occurrence of IMN in diabetic patients (P < 0.05). The receiver operating characteristic (ROC) analysis revealed that the sensitivity of serum MCP-1, MMP-9 and their combination in diagnosing IMN in diabetic patients was 70.73% (95% CI: 0.174, 0.383), 73.98% (95% CI: 0.141, 0.341), and 70.73% (95% CI: 0.042, 0.189), respectively, with a specificity of 73.33% (95% CI: 0.216, 0.383), 77.33% (95% CI: 0.187, 0.348), and 90.67% (95% CI: 0.216, 0.383), and an area under the ROC curve (AUC) of 0.755 (95% CI: 0.656, 0.853), 0.774 (95% CI: 0.677, 0.871), and 0.898 (95% CI: 0.835, 0.962), respectively. The combined serum MCP-1 and MMP-9 exhibited the highest specificity and AUC. The serum levels of MCP-1 and MMP-9 in patients with severe IFTA were higher than those in patients with moderate and mild IFTA (P < 0.05), and they were even higher in individuals with moderate IFTA relative to those with mild IFTA (P < 0.05).Conclusions Serum MCP-1 and MMP-9 levels are associated with the occurrence of IMN in diabetic patients, and the combination of serum MCP-1 and MMP-9 is effective in diagnosing IMN in diabetic patients. Furthermore, MCP-1 and MMP-9 may be related to the presence of IFTA in diabetic patients with IMN.