摘要
目的分析血清甜菜碱同型半胱氨酸甲基转移酶(betaine homocysteine methyltransferase,BHMT)水平与2型糖尿病(type 2 diabetes mellitus,T2DM)患者内脏脂肪面积(visceral fat area,VAF)的关系及其对糖尿病肾病(diabetic nephropathy,DN)的预测价值。方法采取回顾性研究,选择2021年4月至2023年4月山东省临沂市中心医院收治的170例T2DM患者作为研究对象。根据DN发生情况分为两组,将发生DN的患者纳入DN组,将未发生DN患者纳入非DN组。所有患者均接受血清BHMT及VAF检测,并采用双变量相关性分析两者之间的关系。统计患者基线资料,采用二元Logistic回归分析血清BHMT及VAF水平与T2DM患者DN发生的相关性。采用接受者操作特性曲线(receiver operating characteristic curve,ROC)分析血清BHMT及VAF水平对T2DM患者DN发生的预测价值。结果170例T2DM患者发生DN34例,发生率20.00%。DN组合并高血压患者占比为61.76%(21/34),高于非DN组的41.91%(57/136);DN组糖化血红蛋白(glycated hemoglobin,HbA1c)、同型半胱氨酸(homocysteine,Hcy)、VAF水平分别为(8.97±1.53)%、(15.87±5.09)μmol/L、(113.62±18.74)cm2,高于非DN组的(8.16±1.27)%、(11.65±4.81)μmol/L、(92.61±14.17)cm2;DN组BHMT水平为(57.74±9.18)pg/mL,低于非DN组的(78.74±11.53)pg/mL,(P<0.05);DN组血肌酐(serum creatinine,Scr)、血尿素氮(blood urea nitrogen,BUN)、尿白蛋白排泄率(urinary albumin excretion rates,UAER)水平分别为(71.74±9.81)μmol/L、(8.18±1.27)mmol/L、(106.61±28.61)mg/24 h,高于非DN组的(57.11±10.06)μmol/L、(5.29±1.02)mmol/L、(14.65±2.52)mg/24 h,(P<0.05)。BHMT与VAF、Scr、BUN、UAER均成负相关(r<0,P<0.05);二元Logistic回归分析显示,HbA1c、Hcy、VAF高水平是T2DM患者DN发生的危险因素(OR>1,P<0.05);BHMT高水平是T2DM患者DN发生的保护因素(OR<1,P<0.05);ROC曲线结果显示,BHMT、VAF水平及联合预测T2DM患者DN发生的AUC均>0.70,有一定预测价值,其中联合检测最高。结论血清BHMT水平与T2DM患者VAF呈负相关,且血清BHMT及VAF水平与T2DM患者DN发生密切相关,二者能有效预测患者DN的发生风险。
ObjectiveTo analyze the relationship between serum betaine homocysteine methyltransferase(BHMT)level and visceral fat area(VAF)in patients with type 2 diabetes mellitus(T2DM)and its predictive value for diabetic nephropathy(DN).MethodsA retrospective study was conducted to select 170 patients with T2DM admitted to the hospital from Apr.2021 to Apr.2023 as the study subjects.According to the occurrence of DN,the patients were divided into two groups:DN group and non-DN group.All patients were tested for serum BHMT and VAF,and the relationship between them was analyzed by bivariate correlation.The baseline data of patients were collected,and the correlation between serum BHMT and VAF levels and DN in patients with T2DM was analyzed by binary Logistic regression.Receiver operating characteristic curve(ROC)was used to analyze the predictive value of serum BHMT and VAF levels for DN in patients with T2DM.ResultsDN occurred in 34 of 170 patients with T2DM,with an incidence of 20.00%.The proportion of patients with DN combined with hypertension[61.76%(21/34)]was higher than that of non-DN group[41.91%(57/136)].The levels of glycosylated hemoglobin(HbA1c),homocysteine(Hcy)and VAF were(8.97±1.53)%,(15.87±5.09)μmol/L,(113.62±18.74)cm 2 respectively,higher than those in non-DN group[(8.16±1.27)%,(11.65±4.81)μmol/L,(92.61±14.17)cm 2].The level of BHMT was(57.74±9.18)pg/ml,lower than that in non-DN group[(78.74±11.53)pg/ml](P<0.05).The levels of serum creatinine(Scr),blood urea nitrogen(BUN)and urinary albumin excretion rates(UAER)in DN group were(71.74±9.81)μmol/L,(8.18±1.27)mmol/L,(106.61±28.61)mg/24 h respectively,higher than those in non-DN group[(57.11±10.06)μmol/L,(5.29±1.02)mmol/L,(14.65±2.52)mg/24 h](P<0.05).BHMT was negatively correlated with VAF,Scr,BUN and UAER(r<0,P<0.05).Binary Logistic regression analysis showed that high levels of HbA1c,Hcy and VAF were risk factors for DN in patients with T2DM(OR>1,P<0.05).High level of BHMT was a protective factor for DN in patients withT2DM(OR<1,P<0.05).The results of ROC curve showed that the AUC of BHMT,VAF levels and combined prediction of DN in patients with T2DM were all>0.70,which had certain predictive value,and the combined detection had the highest.ConclusionSerum BHMT level is negatively correlated with VAF in patients with T2DM,and serum BHMT and VAF levels are closely related to the occurrence of DN in patients with T2DM,both of which can effectively predict the risk of DN in patients.
作者
胡苹
代燕
李富元
葛明芹
Hu Ping;Dai Yan;Li Fuyuan;Ge Mingqin(Department of Endocrinology,Linyi Central Hospital,Linyi 276400,China)
出处
《中华内分泌外科杂志（中英文）》
CAS
2024年第4期554-558,共5页
Chinese Journal of Endocrine Surgery
基金
临沂市重点研发计划项目(2022YX0019)。
