2 型糖尿病患者尿维生素 D 结合蛋白与早期肾损伤的相关性。
Correlation between urine vitamin Dbinding protein and earlystage renal damage in Type 2 diabetes.
机构信息
Department of Nephrology, Third Xiangya Hospital, Central South University, Changsha 410013.
Department of Nephrology, Yueyang Central Hospital, Yueyang Hunan 414000, China.
出版信息
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2023 Jan 28;48(1):40-48. doi: 10.11817/j.issn.1672-7347.2023.210701.
OBJECTIVES
The excretion of urinary vitamin D-binding protein (uVDBP) is related to the occurrence and development of early-stage renal damage in patients with Type 2 diabetes (T2DM). This study aims to explore the significance of detecting uVDBP in T2DM patients and its relationship with renal tubules, and to provide a new direction for the early diagnosis of T2DM renal damage.
METHODS
A total of 105 patients with T2DM, who met the inclusion criteria, were included as a patient group, and recruited 30 individuals as a normal control group. The general information and blood and urine biochemical indicators of all subjects were collected; the levels of uVDBP, and a marker of tubular injury [urine kidney injury molecule 1 (uKIM-1), urine neutrophil gelatinase-associated lipocalin (uNGAL) and urine retinol-binding protein (uRBP)] were detected by enzyme-linked immunosorbent assay. The results were corrected by urinary creatinine (Cr) to uVDBP/Cr, uKIM-1/Cr, uNGAL/Cr and uRBP/Cr. The Pearson's and Spearman's correlation tests were used to analyze the correlation between uVDBP/Cr and urine albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) and markers of tubular injury, and multivariate linear regression and receiver operating characteristic curve were used to analyze the correlation between uVDBP/Cr and UACR or eGFR.
RESULTS
Compared with the normal control group, the uVDBP/Cr level in the patient group was increased (P<0.05), and which was positively correlated with UACR (r=0.774, P<0.01), and negatively correlated with eGFR (r=-0.397, P<0.01). There were differences in the levels of uKIM-1/Cr, uNGAL/Cr, and uRBP/Cr between the 2 groups (all P<0.01). The uVDBP/Cr was positively correlated with uKIM-1/Cr (r=0.752, P<0.01), uNGAL/Cr (r=0.644, P<0.01) and uRBP/Cr (r=0.812, P<0.01). The sensitivity was 90.0% and the specificity was 82.9% (UACR>30 mg/g) for evaluation of uVDBP/Cr on T2DM patients with early-stage renal damage, while the sensitivity was 75.0% and the specificity was 72.6% for evaluation of eGFR on T2DM patients with early-stage renal damage.
CONCLUSIONS
The uVDBP/Cr can be used as a biomarker in early-stage renal damage in T2DM patients.
目的
尿维生素 D 结合蛋白（uVDBP）的排泄与 2 型糖尿病（T2DM）患者早期肾损伤的发生和发展有关。本研究旨在探讨检测 T2DM 患者 uVDBP 的意义及其与肾小管的关系，为 T2DM 肾损伤的早期诊断提供新方向。
方法
纳入符合纳入标准的 105 例 T2DM 患者作为患者组，招募 30 名健康个体作为正常对照组。收集所有受试者的一般资料和血、尿生化指标；采用酶联免疫吸附法检测 uVDBP 及肾小管损伤标志物[尿肾损伤分子 1（uKIM-1）、尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）和尿视黄醇结合蛋白（uRBP）]。用尿肌酐（Cr）校正 uVDBP/Cr、uKIM-1/Cr、uNGAL/Cr 和 uRBP/Cr。采用 Pearson 和 Spearman 相关检验分析 uVDBP/Cr 与尿白蛋白/肌酐比值（UACR）、估算肾小球滤过率（eGFR）和肾小管损伤标志物的相关性，采用多元线性回归和受试者工作特征曲线分析 uVDBP/Cr 与 UACR 或 eGFR 的相关性。
结果
与正常对照组相比，患者组 uVDBP/Cr 水平升高（P<0.05），且与 UACR 呈正相关（r=0.774，P<0.01），与 eGFR 呈负相关（r=-0.397，P<0.01）。两组间 uKIM-1/Cr、uNGAL/Cr 和 uRBP/Cr 水平差异均有统计学意义（均 P<0.01）。uVDBP/Cr 与 uKIM-1/Cr（r=0.752，P<0.01）、uNGAL/Cr（r=0.644，P<0.01）和 uRBP/Cr（r=0.812，P<0.01）呈正相关。uVDBP/Cr 评估 T2DM 患者早期肾损伤的灵敏度为 90.0%，特异度为 82.9%（UACR>30mg/g），eGFR 评估 T2DM 患者早期肾损伤的灵敏度为 75.0%，特异度为 72.6%。
结论
uVDBP/Cr 可作为 T2DM 患者早期肾损伤的生物标志物。
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