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黄若妃 陈天喜 陈 娟 夏静瑶 陈福宇▲.2型糖尿病患者血清TNF-α水平与糖尿病肾脏疾病相关性研究[J].中国现代医生,2021,59(4):30-33+37+封三
2型糖尿病患者血清TNF-α水平与糖尿病肾脏疾病相关性研究
Study of correlation between serum TNF-α level and diabetic kidney disease in patients with type 2 diabetes mellitus
  
DOI:
中文关键词:  2 型糖尿病  糖尿病肾脏疾病  肿瘤坏死因子α  蛋白尿
英文关键词:Type 2 diabetes mellitus  Diabetic kidney disease  Tumor necrosis factor alpha  Proteinuria
基金项目:浙江省医药卫生科技计划项目(2019RC305)
作者单位
黄若妃 陈天喜 陈 娟 夏静瑶 陈福宇▲ 浙江省永康市第一人民医院内分泌科浙江永康 321300 
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中文摘要:
      目的探讨2 型糖尿病患者外周血中TNF-α 水平与糖尿病肾脏疾病的相关性以及外周血TNF-α 水平用于糖尿病肾脏疾病患者早期诊断的临床价值。方法 选择2018 年9 月至2019 年9 月永康市第一人民医院就诊的DKD 患者50 例,设为糖尿病肾脏疾病组(DKD组),并根据患者尿白蛋白/尿肌酐将DKD 患者分为微量蛋白尿组(n=32)、大量蛋白尿组(n=18),选同期T2DM 不合并DKD 患者200 例,设为单纯糖尿病组(T2DM组)。检测并比较分析两组患者UACR、肾小球滤过率,检测并分析T2DM组患者和DKD组患者以及DKD 患者两个亚组间TNF-α 水平差异,采用Pearson 或Spearman 分析外周血TNF-α 与eGFR 或UACR 的相关性,采用Logistic 多元回归分析法分析TNF-α 水平与DKD 的关系,最后绘制ROC 曲线分析TNF-α、eGFR 或UACR 用于DKD 诊断的特异性和敏感性。结果 DKD组血清TNF-α 水平高于T2DM组患者,且大量蛋白尿组血清TNF-α 水平高于微量蛋白尿和单纯糖尿病组;TNF-α 高水平是DKD 的高危因素;血清TNF-α 分别与UACR 呈正相关(P<0.05),与eGFR 呈负相关。ROC 曲线分析显示,外周血TNF-α 水平检测DKD 的曲线下面积为0.893,95%可信区间为0.675~1.000,敏感性和特异性分别为81.3%和89.3%,高于eGFR 或UACR 检测DKD 的敏感性(73.4%,75.1%)和特异性(80.1%,83.5%)。结论TNF-α 可能参与DKD 进程,在DKD 病情变化中发挥重要作用,并在一定程度上反映肾小球滤过率,可作为DKD 早期诊断的指标。
英文摘要:
      Objective To explore the correlation between TNF-α level in peripheral blood and diabetic kidney disease(DKD) in patients with type 2 diabetes mellitus(T2DM) and the clinical value of TNF-α level in peripheral blood in early diagnosis of DKD.Methods A total of 50 patients with DKD admitted to the First People′s Hospital of Yongkang from September 2018 to September 2019 were selected as DKD group.According to urinary albumin and creatinine,patients with DKD were divided into microalbuminuria group(32 cases) and massive proteinuria group(18 cases).A total of 200 T2DM patients without DKD were selected as simple diabetes group.Urine Albumin-to-Creatinine Ratio(UACR) and glomerular filtration rate were detected and compared between the two groups.The differences of tumor necrosis factor-α (TNF-α) level between T2DM patients,DKD patients and DKD patients in two subgroups were detected and analyzed.Pearson or Spearman was used to analyze the correlation between TNF-α in peripheral blood and eGFR or UACR.Multiple Logistic regression analysis was used to analyze the relationship between TNF-α level and DKD.Finally,ROC curve was drawn to analyze the specificity and sensitivity of TNF-α,eGFR or UACR in the diagnosis of DKD.Results The serum TNF-α level in DKD group was higher than that in T2DM group,and the serum TNF-α level in massive proteinuria group was higher than that in microalbuminuria and simple diabetes group.The high level of TNF-α was a high-risk factor of DKD.Serum TNF-α was positively correlated with UACR(P<0.05) and negatively correlated with eGFR.ROC analyses showed that the area under the curve of peripheral blood TNF-α in the detection of DKD was 0.893,and the 95% confidence interval was 0.675-1.000.The sensitivity and specificity were 81.3% and 89.3%,respectively,which were higher than those of eGFR(sensitivity:73.4%;specificity:80.1%) or UACR(sensitivity:75.1%;specificity:83.5%).Conclusion TNF-α may participate in the process of DKD,playing an important role in the change of DKD,and reflecting glomerular filtration rate to a certain extent,which can be used as a method for early diagnosis of DKD.
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