血清基质交感分子1、视黄醇结合蛋白4水平对高血压肾病患者的诊断价值研究

周麟; 李静; 李毅; 赵明

doi:10.3969/j.issn.1671-2390.2024.02.006

血清基质交感分子1、视黄醇结合蛋白4水平对高血压肾病患者的诊断价值研究

Diagnostic values of serum levels of stromal interaction molecule 1 and retinol binding protein 4 in patients with hypertensive nephropathy

摘要

摘要:
目的探讨基质交感分子1（matrix sympathetic molecule 1，STIM1）、视黄醇结合蛋白4（retinol binding protein 4，RBP4）在高血压肾病患者血清中的表达水平，分析其诊断价值。
方法选取2020年3月至2021年3月三二O一医院收治的高血压肾病患者88例为高血压肾病组，单纯高血压患者88例为高血压组，另外选取同期体检健康者88名为健康组。采用酶联免疫法检测血清STIM1和RBP4水平；Pearson法分析血清STIM1和RBP4水平的相关性及其与血压、肾功能指标的相关性；Logistic回归分析高血压肾病的影响因素；受试者工作特征曲线分析血清STIM1、RBP4水平对高血压肾病的诊断价值。
结果高血压肾病组尿素氮(8.26±3.37)mmol/L比（5.46±2.31）mmol/L、(5.63±2.54)mmol/L、尿酸(375.53±71.41)μmol/L比(342.80±59.75)μmol/L、(352.68±65.24)μmol/L、血肌酐(105.34±34.19)μmol/L比(68.31±20.19)μmol/L、(71.63±22.55)μmol/L显著高于健康组和高血压组（P＜0.05），估算肾小球滤过率（estimated glomerular filtration rate，eGFR）显著低于健康组和高血压组（P＜0.05）；健康组、高血压组、高血压肾病组血清STIM1(30.61±6.25)μg/L、(36.63±8.27)μg/L、(48.10±11.06)μg/L、RBP4(42.26±5.23)ng/mL、(51.98±8.70)ng/mL、(66.61±13.79)ng/mL水平显著依次增高，两两比较差异有统计学意义（P＜0.05）；高血压肾病组血清中STIM1、RBP4的水平呈正相关；高血压肾病组血清STIM1、RBP4水平与尿素氮、尿酸、血肌酐呈正相关，与eGFR呈负相关（P均＜0.05）；Logistic多因素回归分析得知STIM1高表达、RBP4高表达、血肌酐、eGFR是影响高血压患者发生高血压肾病的独立危险因素（P＜0.05）；血清STIM1、RBP4诊断高血压患者发生高血压肾病的曲线下面积为0.798、0.744，二者联合诊断高血压肾病的曲线下面积为0.852，灵敏度为75.29%，特异度为88.21%，二者联合优于血清STIM1、RBP4各自单独诊断（Z_{联合vsSTIM1} = 2.219、Z_联合vsRBP4 = 3.385，P均＜0.05）。
结论血清STIM1、RBP4水平在高血压肾病患者中呈现高表达，二者联合对于高血压肾病具有一定诊断价值。

Abstract:
Objective To explore the serum expressions of stromal interaction molecule 1 (STIM1) and retinol binding protein 4 (RBP4) in patients with hypertensive nephropathy (HN) and examine their diagnostic values.(375.53±71.41)μmol/Lvs(342.80±59.75)μmol/L、(352.68±65.24)μmol/L.
Methods From March 2020 to March 2021, 88 hospitalized HN patients were selected as HN group while another 88 patients with simple hypertension as hypertensive group. Also 88 healthy people dring the same period were chosen as healthy group. Serum levels of STIM1 and RBP4 were detected by enzyme-linked immunosorbent assay (ELISA). Pearson’s method was utilized for examining the correlation between serum levels of STIM1 and RBP4, blood pressure and renal function parameters. Logistic regression analysis was employed for analyzing the influencing factors of HN. Receiver operating characteristic (ROC) curve was plotted for determining the diagnostic value of serum levels of STIM1 and RBP4 in HN.
Results Urea nitrogen(8.26±3.37)mmol/L vs（5.46±2.31）mmol/L、(5.63±2.54)mmol/L, uric acid(375.53±71.41)μmol/L vs(342.80±59.75)μmol/L、(352.68±65.24)μmol/L, serum creatinine(105.34±34.19)μmol/L vs(68.31±20.19)μmol/L、(71.63±22.55)μmol/L and estimated glomerular filtration rate (eGFR) were obviously higher in HN group than those in healthy and hypertensive groups (P<0.05). The serum levels of STIM1(30.61±6.25)μg/L、(36.63±8.27)μg/L、(48.10±11.06)μg/L and RBP4(42.26±5.23)ng/mL、(51.98±8.70)ng/mL、(66.61±13.79)ng/mLspiked successively in healthy, hypertensive and HN groups (P<0.05). Serum levels of STIM1 and RBP4 were correlated positively in HN group. Serum levels of STIM1 and RBP4 were correlated positively with urea nitrogen, uric acid and serum creatinine and negatively with eGFR in HN group (P<0.05). Logistic multivariate regression analysis indicated that elevated levels of STIM1, RBP4, serum creatinine and eGFR were independent risk factors for HN in hypertensive patients (P<0.05). In hypertensive patients, area under the curve (AUC) of serum STIM1/RBP4 for diagnosing HN was 0.798 and 0.744. And AUC of a combined diagnosis of HN was 0.852 with a sensitivity of 75.29% and a specificity of 88.21%. The values were better than those for serum STIM1/RBP4 for a separate diagnosis (Z combined vs STIM1=2.219, Z combined vsRBP4=3.385, P<0.05).
Conclusion Serum levels of STIM1 and RBP4 are up-regulated in HN patients and a combination of STIM1 and RBP4 has some diagnostic value for HN.

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