血清Fetuin-A、NGAL对糖尿病肾病的早期诊断价值

Early diagnostic value of serum Fetuin-A and NGAL in patients with diabetic nephropathy

摘要:

目的 探讨糖尿病肾病（DN）患者血清胎球蛋白A（Fetuin-A）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）变化及早期诊断DN的价值。方法 选取2018年9月—2021年12月徐州医科大学附属宿迁医院收治的73例DN患者为研究组，另选取同期该院收治的单纯糖尿病患者61例为对照组，研究组按病情严重程度又分为正常白蛋白尿DN组、微量白蛋白尿DN组及大量白蛋白尿DN组。收集比较研究组与对照组患者的基本资料。采用酶联免疫吸附试验检测血清Fetuin-A、NGAL水平。采用多因素逐步Logistic回归模型分析影响糖尿病患者发生DN的因素。绘制受试者工作特征（ROC）曲线分析血清Fetuin-A、NGAL诊断DN的价值。结果 研究组UAER、血肌酐、CysC、Fetuin-A、NGAL高于对照组（P <0.05）。大量白蛋白尿DN组的Fetuin-A、NGAL水平高于正常白蛋白尿DN组和微量白蛋白尿DN组（P <0.05），微量白蛋白尿DN组的Fetuin-A、NGAL水平高于正常白蛋白尿DN组（P <0.05）。多因素逐步Logistic回归分析显示，尿白蛋白排泄率（UAER）［O^R=9.612（95% CI：3.955，23.360）］、Fetuin-A［O^R=5.058（95% CI：2.081，12.293）］、NGAL［O^R=5.490（95% CI：2.259，13.343）］是影响糖尿病患者出现DN的危险因素（P <0.05）。ROC曲线分析结果显示，血清Fetuin-A、NGAL及两者联合诊断糖尿病患者发生DN的敏感性分别为71.23%（95% CI：0.593，0.809）、73.97%（95% CI：0.622，0.832）、71.23%（95% CI：0.593，0.809），特异性分别为70.49%（95% CI：0.573，0.811）、75.41%（95% CI：0.624，0.852）、95.08%（95% CI：0.854，0.987），AUC分别为0.720（95% CI：0.608，0.831）、0.759（95% CI：0.659，0.860）、0.893（95% CI：0.817，0.968）。结论 血清Fetuin-A联合NGAL早期诊断DN效能良好，且Fetuin-A、NGAL与DN病情有关。

Abstract:

Objective To investigate the changes of serum fetuin A (Fetuin-A) and neutrophil gelatinase-associated lipocalin (NGAL) in patients with diabetic nephropathy (DN) and the value of early diagnosis of DN.Methods Seventy-three DN patients admitted to the hospital from September 2018 to December 2021 were selected as the research group, and 61 simple diabetic patients admitted to the hospital during the same period were selected as the control group. The basic data of the two groups of patients were collected, the factors affecting the occurrence of DN in diabetic patients were analyzed, the value of serum Fetuin-A and NGAL in the diagnosis of DN was analyzed, and the serum Fetuin-A and NGAL levels of DN patients with different conditions in the study group were analyzed.Results Urinary albumin excretion rate, serum creatinine, CysC, Fetuin-A, and NGAL in the study group were higher than those in the control group (P < 0.05). The levels of Fetuin-A and NGAL in DN group with massive albuminuria were higher than those in DN group with normal albuminuria and DN group with microalbuminuria (P <0.05), and the levels of Fetuin-A and NGAL in DN group with microalbuminuria were higher than those in DN group with normal albuminuria (P < 0.05). Logistic multivariate regression analysis showed that UAER [O^R = 9.612 (95% CI: 3.955, 23.360) ], Fetuin-A [O^R = 5.058 (95% CI: 2.081, 12.293) ], and NGAL [O^R = 5.490 (95% CI: 2.259, 13.343) ] levels were the risk factors for DN in diabetic patients (P < 0.05). The ROC curve results showed that the sensitivities of serum Fetuin-A, NGAL and their combination to diagnose DN in diabetic patients were 71.23% (95% CI: 0.593, 0.809), 73.97% (95% CI: 0.622, 0.832), and 71.23% (95% CI: 0.593, 0.809), respectively; specificities were 70.49% (95% CI: 0.573, 0.811), 75.41% (95% CI: 0.624, 0.852), 95.08% (95% CI: 0.854, 0.987) , respectively; AUC were 0.720 (95% CI: 0.608, 0.831), 0.759 (95% CI: 0.659, 0.860), 0.893 (95% CI: 0.817, 0.968), respectively.Conclusion Serum Fetuin-A combined with NGAL has a good effect on early diagnosis of DN, and Fetuin-A and NGAL are related to the disease of DN.