摘要
目的探讨2型糖尿病肾病并发肌少症患者血清中沉默信息调节因子1(SIRT1)和血胰岛素样生长因子-1(IGF-1)水平的变化。方法选取2021年12月至2023年12月在曲靖市第二人民医院确诊的2型糖尿病肾病患者168例为病例组,其中单纯2型糖尿病肾病患者112例,并发肌少症患者56例;选取同期入院的健康志愿者82例设为对照组。收集所有研究对象的一般临床资料,并采用酶联免疫吸附法检测SIRT1和IGF-1水平。结果与单纯2型糖尿病肾病组相比,并发肌少症组尿酸、血清肌酐、尿白蛋白与肌酐比值(UACR)、胰岛素抵抗指数、低密度脂蛋白胆固醇均上升(P<0.05),握力、步速、25-羟基维生素D3[25(OH)D3]均下降(P<0.05)。SIRT1水平并发肌少症组<单纯2型糖尿病肾病组<对照组(P<0.05);IGF-1水平并发肌少症组>单纯2型糖尿病肾病组>对照组(P<0.05)。并发肌少症组患者SIRT1水平与握力、步速、25(OH)D3呈正相关(P<0.05),与尿酸、血清肌酐、UACR、胰岛素抵抗指数、低密度脂蛋白胆固醇呈负相关(P<0.05);IGF-1水平与临床指标相关性则相反(P<0.05)。SIRT1、25(OH)D3均为并发肌少症的保护因素(OR=0.856、0.547,P<0.05);IGF-1、尿酸、UACR均为危险因素(OR=1.307、1.846、1.453,P<0.05);两者联合预测并发肌少症的AUC为0.931,敏感性、特异性分别为92.86%、75.00%,优于各自单独预测(Z_(两者联合-IGF-1)=2.936、Z_(两者联合-SIRT1)=1.989,P=0.003、P=0.047)。结论2型糖尿病肾病并发肌少症患者血清IGF-1水平上升,SIRT1水平下降,两者联合分析对该疾病具有较高的预测价值。
Objective To explore the changes of serum silent information regulator 1(SIRT1)and insulin-like growth factor-1(IGF-1)levels in patients with type 2 diabetic nephropathy complicated with sarcopenia.Methods A total of 168 patients with type 2 diabetic nephropathy diagnosed in Qujing Second People's Hospital from December 2021 to December 2023 were selected as the case group,including 112 patients with simple type 2 diabetic nephropathy and 56 patients complicated with sarcopenia.A total of 82 healthy volunteers admitted to the hospital during the same period were selected as the control group.The general clinical data of the two groups were collected.And the levels of SIRT1 and IGF-1 were detected by enzyme-linked immunosorbent assay.Results Compared with the simple type 2 diabetic nephropathy group,the group with concurrent sarcopenia demonstrated increased levels of uric acid(UA),serum creatinine(Scr),urinary albumin creatinine ratio(UACR),insulin resistance index(IRI),and low-density lipoprotein cholesterol(LDL-C)(P<0.05),but decreased levels of grip strength,gait speed,and 25-hydroxyvitamin D3[25(OH)D3](P<0.05).The SIRT1 level in the group with concurrent sarcopenia was lower than that in the simple type 2 diabetic nephropathy group and the control group(P<0.05).On the contrary,the IGF-1 level in the group with concurrent sarcopenia was higher than that in the simple type 2 diabetic nephropathy group and the control group(P<0.05).In patients with concurrent sarcopenia,the SIRT1 level was positively correlated with grip strength,gait speed and 25(OH)D3(P<0.05),but negatively correlated with UA,Scr,UACR,IRI,and LDL-C(P<0.05),while IGF-1 level showed the opposite correlation(P<0.05).SIRT1 and 25(OH)D3 levels were protective factors for type 2 diabetic nephropathy complicated with concurrent sarcopenia(OR=0.856,0.547,P<0.05),while levels of IGF-1,UA,and UACR were risk factors(OR=1.307,1.846,1.453,P<0.05).The area under the receiver operator characteristic curve(AUC)of the combined prediction of SIRT1 and IGF-1 levels for concurrent sarcopenia was 0.931,with a sensitivity of 92.86%and a specificity of 75.00%,which were superior to those of individual predictions(Z_(combined-IGF-1)=2.936,Z_(combined-SIRT1)=1.989,P=0.003,P=0.047).Conclusion Serum levels of IGF-1 are increased and SIRT1 decreased in patients with type 2 diabetic nephropathy complicated with sarcopenia.The combined analysis of the two indicators has a high predictive value for the disease.
作者
田林玉
肖宏
周朴
王金瑞
薛平燕
Tian Linyu;Xiao Hong;Zhou Pu;Wang Jinrui;Xue Pingyan(Department of Endocrinology,Qujing Second People's Hospital,Qujing 655000,China)
出处
《成都医学院学报》
2025年第5期795-799,共5页
Journal of Chengdu Medical College
基金
云南省科学技术厅科技计划项目(No:202101AZ070001-017)。
