双肾血流阻力指数联合脂肪特异性丝氨酸蛋白酶抑制剂预测2型糖尿病肾脏疾病患者肾功能的价值

    Value of blood flow resistance index plus Vaspin in predicting renal function in patients with type 2 diabetic nephropathy

      摘要
    • 摘要:
      目的  探讨双肾血流阻力指数联合脂肪特异性丝氨酸蛋白酶抑制剂（visceral adipose tissue-derived serine protease inhibitor，Vaspin）预测2型糖尿病肾脏疾病患者肾功能的价值。
      方法  选取2021年8月至2022年8月秦皇岛市第一医院收治的108例2型糖尿病肾脏疾病患者，入院后进行彩色多普勒超声检查，测量患者双肾血流阻力指数，将患者分为肾血流阻力指数升高组40例和肾血流阻力指数正常组68例。采用酶联免疫吸附试验检测血清Vaspin水平，并搜集患者临床资料；采用单因素和多因素Logistic回归分析影响肾血流阻力指数升高的危险因素。采用Pearson分析肾血流阻力指数、Vaspin与临床资料的关系，根据肾血流阻力指数、Vaspin绘制受试者工作特征曲线，以曲线下面积评估其对2型糖尿病肾脏疾病患者肾功能的预测价值。
      结果  两组患者性别、糖尿病肾脏疾病分期、尿蛋白定量、血白蛋白、糖化血红蛋白、血尿酸、尿白蛋白与肌酐比值、尿α1微球蛋白、尿β2微球蛋白等一般资料比较差异均无统计学意义（P＞0.05）；肾血流阻力指数升高组患者年龄（56.33 ± 5.19）岁比（50.78 ± 5.24）岁、糖尿病病程（12.58 ± 3.42）年比（10.13 ± 3.25）年］、高血压（87.50%比61.76%）高于肾血流阻力指数正常组，而三酰甘油［（1.72 ± 0.45）mmol/L比（2.11 ± 0.58）mmol/L］、低密度脂蛋白［（2.33 ± 0.57）mmol/L比（2.61 ± 0.62）mmol/L］、血红蛋白［（102.39 ± 21.64）g/L比（113.76 ± 28.45）g/L］、左肾体积［（76.58 ± 15.33）cm3比（81.35 ± 17.16）cm3］、右肾体积［（71.62 ± 12.39）cm3比（80.47 ± 16.51）cm3］、估算肾小球滤过率［（40.37 ± 12.58）mL·min−1·（1.73 m2）−1比（52.14 ± 13.26）mL·min−1·（1.73 m2）−1］、血清Vaspin水平［（1.52 ± 0.38）μg/L比（1.74 ± 0.43）μg/L］低于肾血流阻力指数正常组（P＜0.05）。Pearson相关性分析结果显示，肾血流阻力指数与低密度脂蛋白、估算肾小球滤过率、血清Vaspin呈负相关关系（P＜0.05），与血肌酐、尿白蛋白与肌酐比值呈正相关关系（P＜0.05）。多因素Logistic回归分析结果显示，年龄≥55岁（OR = 1.061，95%CI：1.036～1.086）、血肌酐升高（OR = 1.012，95%CI：1.004～1.020）、估算肾小球滤过率升高（OR = 1.037，95%CI：1.007～1.068）、血清Vaspin下降（OR = 1.132，95%CI：1.053～1.217）是影响肾血流阻力指数升高的独立危险因素（P＜0.05）。双肾血流阻力指数联合Vaspin预测2型糖尿病肾脏疾病患者肾功能进展的曲线下面积为0.79，敏感性和特异性分别为82.49%、68.73%。
      结论  双肾血流阻力指数升高、血清Vaspin水平降低是影响2型糖尿病肾脏疾病患者肾功能的独立危险因素，二者联合检测对预测2型糖尿病肾脏疾病患者肾功能进展具有较好预测价值。

       

      Abstract:
      Objective  To explore the value of blood flow resistance index of both kidneys plus visceral adipose tissue-derived serine protease inhibitor (Vaspin) in predicting renal function in patients with type 2 diabetic nephropathy (T2DN).
      Methods  From August 2021 to August 2022, 108 T2DN patients were recruited. Color ultrasonography was performed after admission for measuring renal indices. They were divided into two groups of elevated blood flow resistance index (n=40) and normal renal index (n=68). Serum level of Vaspin was detected by MeAP immunosorbent assay. The relevant clinical data were recorded. The risk factors affecting an elevation of renal indices were analyzed by univariate and multivariate Logistic regression. Pearson’s method was employed for examining the relationship between renal indices, Vaspin and renal function. Receiver operating characteristic (ROC) curve was plotted according to renal indices and Vaspin. And the area under the curve (AUC) was utilized for evaluating its predictive value of renal function in T2DN patients.
      Results  No significant inter-group differences existed in gender, stage of diabetic kidney disease, quantitative urinary protein, blood albumin, glycosylated hemoglobin, blood uric acid, urinary albumin to creatinine ratio, urinary α1 microglobulin or urinary β2 microglobulin (P>0.05). Age (56.33±5.19) year vs (50.78±5.24) year, duration of diabetes (12.58±3.42) years vs (10.13±3.25) years and hypertension (87.50% vs 61.76%) were higher in elevated renal blood flow resistance index group than those in normal group. Triglyceride (1.72±0.45) mmol/L vs (2.11±0.58) mmol/L, low-density lipoprotein (LDL) (2.33±0.57) mmol/L vs (2.61±0.62) mmol/L, hemoglobin (102.39±21.64) g/L vs (113.76±28.45) g/L, left kidney volume (76.58±15.33) cm3 vs (81.35±17.16) cm3, right kidney volume (71.62±12.39) cm3 vs (80.47±16.51) cm3, estimated glomerular filtration rate (eGFR) (40.37±12.58) mL·min−1·(1.73 m2)−1 vs (52.14±13.26) mL·min−1·(1.73 m2)−1 and serum level of Vaspin (1.52±0.38) μg/L vs (1.74±0.43) μg/L were lower than those in normal group (P<0.05). Pearson’s correlation analysis revealed that renal blood flow resistance index was correlated negatively with LDL, eGFR and serum level of Vaspin (P<0.05) and positively with serum creatinine and urinary albumin-to-creatinine ratio (P<0.05). Multivariate Logistic regression analysis showed that age ≥55 years (OR=1.061, 95%CI: 1.036-1.086), elevated serum creatinine (OR=1.012, 95%CI: 1.004-1.020) and higher estimated glomerular filtration rate (OR=1.037, 95%CI: 1.007-1.068) and lowered serum Vaspin (OR=1.132, 95%CI: 1.053-1.217) were independent risk factors for elevated renal blood flow resistance index (P<0.05). The area under the curve (AUC) of birenal blood flow resistance index plus Vaspin predicted renal function progression in T2DN patients was 0.79 with a sensitivity of 82.49% and a specificity of 68.73%.
      Conclusions  Elevated blood flow resistance index in both kidneys and lower serum level of Vaspin are independent risk factors affecting renal function. A combined detection of both has an excellent predictive value for the progression of renal function in T2DN patients.

       

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