血清超敏C反应蛋白、白细胞介素27检测对糖尿病肾病的早期诊断价值

The value of serum hs-CRP and IL-27 in the early diagnosis of diabetic nephropathy

摘要:

目的 探讨血清超敏C反应蛋白（hs-CRP）、白细胞介素27（IL-27）对糖尿病肾病（DN）的早期诊断价值。方法 选取2020年1月—2021年7月于青岛市海慈医院住院治疗的DN患者146例作为观察组，同时选取同期该院就诊的糖尿病患者60例作为对照组。比较两组患者的收缩压、舒张压、体质量指数（BMI）、空腹血糖（FPG）、餐后2小时血糖（2 hPG）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、hs-CRP、IL-27水平以及尿白蛋白/肌酐比值（UACR）、肾小球滤过率估计值（eGFR）。采用逐步多因素非条件Logistic回归模型分析DN发生、发展的影响因素，采用受试者工作特征（ROC）曲线预测血清hs-CRP、IL-27水平对DN的早期诊断价值。结果 观察组TC、TG、LDL-C、hs-CRP、IL-27、UACR水平高于对照组组，eGFR水平低于对照组（P <0.05）。两组FPG、2 hPG、HDL-C水平比较，差异无统计学意义（P >0.05）。逐步多因素非条件Logistic回归模型分析结果显示，TC水平［O^R=1.721（95% CI：1.187，2.495），P <0.05］、hs-CRP水平［O^R=2.409（95% CI：1.477，3.929），P <0.05］、IL-27水平［O^R=1.987（95% CI：1.256，3.145）］及UACR值［O^R=1.693（95% CI：1.127，2.543），P <0.05］是DN的影响因素。ROC曲线分析结果显示：hs-CRP、IL-27单独诊断时AUC为0.769（95% CI：0.596，0.941）、0.827（95% CI：0.717，0.939）。而联合诊断时AUC为0.895（95% CI：0.848，0.929），诊断效能较高。结论 血清hs-CRP、IL-27水平升高是DN的影响因素，血清hs-CRP、IL-27可以作为DN的早期诊断指标。

Abstract:

Objective To investigate the value of serum high-sensitivity C-reactive protein (hs-CRP) and interleukin-27 (IL-27) in the early diagnosis of diabetic nephropathy (DN).Methods A total of 146 DN patients who were hospitalized in Qingdao Haici Hospital from January 2020 to July 2021were selected as the observation group, and 60 patients with diabetes mellitus yet without DN were included as the control group. The systolic blood pressure, diastolic blood pressure, body mass index (BMI), fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2 hPG), serum levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), hs-CRP, and IL-27, urinary albumin-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR) were measured and compared between the two groups of patients. Multivariable Logistic regression was used to analyze the risk factors that affected the occurrence of DN. The receiver operating characteristic (ROC) curve was applied to analyze the value of serum hs-CRP and IL-27 for the early diagnosis of DN.Results The levels of TC, TG, LDL-C, hs-CRP and IL-27 as well as the UACR in the observation group were higher than those in the control group (P < 0.05), whereas the eGFR in the observation group was lower than that in the control group (P < 0.05). There was no difference in the levels of FPG, 2 hPG and HDL-C between the two groups (P < 0.05). Multivariable Logistic regression analysis showed that TC level [O^R = 1.721, (95% CI: 1.187, 2.495) ], hs-CRP level [O^R = 2.409, (95% CI: 1.477, 3.929) ], IL-27 level [O^R = 1.987, (95% CI: 1.256, 3.145) ] and UACR [O^R = 1.693, (95% CI: 1.127, 2.543) ] were factors affecting the occurrence of DN (P < 0.05). The area under the ROC curve (AUC) of hs-CRP and that of IL-27 for predicting the occurrence of DN were 0.769 (95% CI: 0.596, 0.941) and 0.827 (95% CI: 0.717, 0.939), respectively. The AUC of the combined detection of the hs-CRP and IL-27 for the diagnosis of DN was 0.895 (95% CI: 0.848, 929), which was higher than that where the two indicators were applied alone.Conclusions The increased serum levels of hs-CRP and IL-27 are risk factors for DN, and the serum levels of hs-CRP and IL-27 can be established as early diagnostic indicators for DN.