Nrf2/8-OHdG联合检测在湘西地区糖尿病肾病合并高尿酸血症中的诊断价值研究

Diagnostic value of combined Nrf2 and 8-OHdG in diabetic kidney disease with hyperuricemia in Xiangxi region

摘要:

目的 探讨Nrf2/8-OHdG联合检测在湘西地区糖尿病肾病（DKD）合并高尿酸血症（HUA）中的诊断价值。方法 前瞻性选取2024年9月—2025年8月凤凰县民族中医院收治的92例DKD患者作为研究对象。根据是否合并HUA将患者分为观察组（DKD合并HUA）和对照组（单纯DKD），各46例。比较两组患者的糖代谢指标［空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）］、估算肾小球滤过率（eGFR）和氧化应激指标［超氧化物歧化酶（SOD）、丙二醛（MDA）、8-OHdG、Nrf2］。构建多因素一般Logistic回归模型，分析DKD合并HUA的影响因素。绘制受试者工作特征（ROC）曲线，分析氧化应激指标对DKD合并HUA的诊断效能。结果 两组FPG、2hPG、HbA1c比较，差异均无统计学意义（P 0.05），对照组eGFR高于观察组（P 0.05）。对照组SOD、Nrf2均高于观察组（P 0.05），MDA、8-OHdG均低于观察组（P 0.05）。多因素一般Logistic回归分析结果显示：8-OHdG升高、Nrf2降低是DKD合并HUA的危险因素（P 0.05）；eGFR升高是DKD合并HUA的保护因素（P 0.05）。ROC曲线分析结果显示，eGFR、Nrf2、8-OHdG联合检测的曲线下面积、特异性均最高，分别为0.880（95% CI：0.812，0.949）、91.3%（95% CI：0.823，0.980），约登指数最大为0.674。eGFR的敏感性最高，为90.7%（95% CI：0.815，0.977）。结论 eGFR、Nrf2、8-OHdG是评估疾病状态的重要指标，三者联合检测可显著提升诊断效能。针对Nrf2、8-OHdG的监测与干预有望为优化DKD合并HUA治疗方案提供新方向。

Abstract:

Objective To explore the diagnostic value of the combined detection of Nrf2 and 8-OHdG in diabetic kidney disease (DKD) complicated by hyperuricemia in the Xiangxi region.Methods A prospective investigation was carried out on 92 DKD patients admitted to the Fenghuang County Hospital of Traditional Chinese Medicine from September 2024 to August 2025. Based on the presence or absence of hyperuricemia, the patients were divided into an observation group (DKD complicated by hyperuricemia) and a control group (simple DKD), with 46 cases in each group. Glucose metabolism indices [fasting plasma glucose (FPG), 2-hour post-prandial plasma glucose (2hPG), glycated hemoglobin (HbA1c) ], estimated glomerular filtration rate (eGFR), and oxidative stress indices [superoxide dismutase (SOD), malondialdehyde (MDA), 8-hydroxydeoxyguanosine (8-OHdG), nuclear factor erythroid 2-related factor 2 (Nrf2) ] were compared between the two groups. A multivariate general Logistic regression model was established to analyze the influencing factors of DKD complicated by hyperuricemia. The receiver operating characteristic (ROC) curve was plotted to assess the diagnostic efficacy of oxidative stress indices for DKD complicated by hyperuricemia.Results No statistically significant differences were observed in FPG, 2hPG, or HbA1c between the two groups (all P 0.05). The eGFR in the control group was higher than that in the observation group (P 0.05). The levels of SOD and Nrf2 in the control group were higher than those in the observation group (both P 0.05), while the levels of MDA and 8-OHdG were lower than those in the observation group (both P 0.05). Multivariate general Logistic regression analysis showed that elevated 8-OHdG and decreased Nrf2 were risk factors for DKD-hyperuricemia (both P 0.05), whereas elevated eGFR was a protective factor for DKD complicated by hyperuricemia (P 0.05). ROC curve analysis revealed that the combined detection of eGFR, Nrf2, and 8-OHdG had the highest area under the curve (AUC) and specificity, which were 0.880 (95% CI: 0.812, 0.949) and 91.3% (95% CI: 0.823, 0.980), respectively, with the maximum Youden index of 0.674. eGFR exhibited the highest sensitivity of 90.7% (95% CI: 0.815, 0.977).Conclusion eGFR, Nrf2, and 8-OHdG serve as crucial indicators for assessing disease status; combined testing of these three markers significantly enhances diagnostic accuracy. Monitoring and intervention strategies targeting Nrf2 and 8-OHdG hold promise for offering a novel direction to optimize therapeutic regimens for DKD complicated by hyperuricemia.