摘要
目的研究糖尿病肾脏疾病(diabetic kidney disease,DKD)患者血清中谷胱甘肽过氧化物酶3(glutathione peroxidase 3,GPX3)、泛联蛋白1(pannexin 1,PANX1)、白细胞介素(interleukin,IL)17表达水平及其与肾损伤的关系。方法选择2021年5月12日至2023年6月12日在西安国际医学中心医院收治的88例DKD患者为DKD组,根据尿白蛋白肌酐比值(urinary albumin to creatinine ra⁃tio,UACR)评估患者的肾损伤程度,分为轻度DKD组(n=52)和重度DKD组(n=36),另选择同期就诊的62例单纯糖尿病(diabetes mellitus,DM)患者为DM组。采用酶联免疫吸附法检测血清GPX3、PANX1、IL-17表达水平;采用Pearson相关分析血清GPX3、PANX1、IL-17与DKD患者肾临床指标和损伤指标[肾小球滤过率(glomerular filtration rate,GFR)、UACR]的相关性;采用多因素Logistic回归分析DKD患者肾损伤程度的影响因素;采用受试者工作特征曲线评估血清GPX3、PANX1、IL-17对DKD患者发生肾损伤和其严重程度的诊断价值。结果DKD组患者三酰甘油[(2.17±0.56)mmol/L比(1.98±0.35)mmol/L]、总胆固醇[(5.36±1.38)mmol/L比(4.97±0.63)mmol/L]、低密度脂蛋白胆固醇[(3.34±0.48)mmol/L比(3.18±0.41)mmol/L]水平显著高于DM组(P<0.05)。随着病情严重程度增加,GFR、血清GPX3水平逐渐降低,重度DKD组最低[GFR(12.34±2.15)mL/min、血清GPX3(189.57±39.98)μg/L],轻度DKD组次之[GFR(52.28±10.12)mL/min、血清GPX3(309.06±100.00)μg/L],DM组最高[GFR(87.14±10.28)mL/min、血清GPX3(389.54±110.00)μg/L](P<0.05);UACR以及血清PANX1、IL-17水平逐渐升高,重度DKD组最高[UACR(382.44±40.75)mg/g、血清PANX1(2149.57±49.80)ng/L、IL-17(60.23±5.75)ng/L],轻度DKD组次之[UACR(132.69±20.14)mg/g、血清PANX1(1969.77±219.60)ng/L、IL-17(0.05±0.00)ng/L],DM组最低[UCER(15.14±3.22)mg/g、血清PANX1(1820.06±139.90)ng/L、IL-17(0.04±0.01)ng/L](P<0.05)。DKD患者血清GPX3水平与总胆固醇、三酰甘油、低密度脂蛋白胆固醇、UACR呈负相关关系(r=-0.564、-0.427、-0.424、-0.562),与GFR呈正相关关系(r=0.632,P<0.05),DKD患者血清PANX1、IL-17水平与总胆固醇(r=0.491、0.613)、三酰甘油(r=0.485、0.421)、低密度脂蛋白胆固醇(r=0414、0.443)、UACR(r=0.439、0.533)呈正相关关系,与GFR呈负相关关系(r=-0.666、-0.653,P<0.05)。GFR、UACR及血清GPX3、PANX1、IL-17是DKD患者肾损伤严重程度的影响因素(P<0.05)。血清GPX3、PANX1、IL-17以及三者联合评估DKD患者发生肾损伤及肾损伤严重程度的曲线下面积分别为0.922、0.980,三者联合诊断优于各自独自诊断。结论DKD患者血清GPX3低表达,PANX1、IL-17高表达,与DKD患者发生肾损伤和肾损伤严重程度密切相关,三者联合检测有利于诊断DKD患者肾损伤发生和严重程度。
Objective To detect serum glutathione peroxidase 3(GPX3),pannexin 1(PANX1),and interleukin(IL)-17 levels in patients with diabetic kidney disease(DKD)and their correla⁃tion with DKD.Methods From May 12,2021,and June 12,2023,88 DKD patients with admitted to Xi'an International Medical Center Hospital were selected as DKD group.Based on the severity of DKD evaluated according to urinary albumin to creatinine rate(UACR),patients were assigned into the mild DKD group(n=52)and severe DKD group(n=36).Meantime,62 patients with diabetes mellitus(DM)who were diagnosed during the same period were selected as DM group.Enzyme-linked immunosorbent assay was applied to detect serum glutathione peroxidase 3(GPX3),pannexin 1(PANX1),and interleu⁃kin 17(IL-17)levels.Pearson correlation was applied to analyze the correlation of serum GPX3,PANX1,and IL-17 levels with renal clinical indexes and kidney injury markers(glomerular filtration rate[GFR],UACR in DKD patients.Multivariate logistic regression was applied to analyze the influencing factors for DKD and its severity.Receiver operating characteristic(ROC)curve was applied to evaluate the diagnos⁃tic value of serum GPX3,PANX1,and IL-17 in assessing the occurrence and the severity of DKD.Results Patients in the DKD group had significantly higher triglyceride[(2.17±0.56)mmol/L vs(1.98±0.35)mmol/L],total cholesterol[(5.36±1.38)mmol/L vs(4.97±0.63)mmol/L],and lowdensity lipoprotein cholesterol[(3.34±0.48)mmol/L vs(3.18±0.41)mmol/L]than those in the DM group(P<0.05).GFR and serum GPX3 levels gradually decreased with the worsening of DKD.Patients in the DM group had the highest levels of GFR and GPX3[GFR:(87.14±10.28)mL/min;GPX3:(389.54±110.00)μg/L],followed by the mild DKD group[GFR:(52.28±10.12)mL/min,GPX3:(309.06±100.00)μg/L]and severe DKD group[GFR:(12.34±2.15)mL/min,GPX3:(189.57±39.98)μg/L](P<0.05).UACR and serum PANX1 and IL-17 levels gradually increased with the wors⁃ening of DKD.Patients in the severe DKD group had the highest UACR,PANX1 and IL-17 levels[UACR:(382.44±40.75)mg/g;PANX1:(2149.57±49.80)ng/L;IL-17:(60.23±5.75)ng/L],fol⁃lowed by the mild DKD group[UACR:(132.69±20.14)mg/g;PANX1:(1969.77±219.60)ng/L;IL-17:(0.05±0.00)ng/L]and DM group[UACR:(15.14±3.22)mg/g;PANX1:(1820.06±139.90)ng/L;IL-17:(0.04±0.01)ng/L](P<0.05).Serum GPX3 levels in DKD patients were negatively cor⁃related with total cholesterol,triglycerides,low-density lipoprotein cholesterol,and UACR(r=-0.564,-0.427,-0.424,and-0.562,respectively),and positively correlated with GFR(r=0.632,P<0.05).Se⁃rum PANX1 and IL-17 levels in DKD patients were positively correlated with total cholesterol(r=0.491、0.613),triglycerides(r=0.485、0.421),low-density lipoprotein cholestero(l r=0.414、0.443),and UACR(r=0.439、0.533),and negatively correlated with GFR(r=-0.666,-0.653,P<0.05).GFR,UACR,GPX3,PANX1,and IL-17 were influencing factors for the severity of DKD(P<0.05).The area under the curve(AUC)of a combination of serum GPX3,PANX1,and IL-17 in assessing the occurrence and the severity of DKD was 0.922 and 0.980,respectively.The combined diagnosis of the three was superior to their individual diagnosis.Conclusion Serum GPX3 level is low in DKD patients,while PANX1 and IL-17 levels are high,.They are closely related to the occurrence and severity of DKD.A combination of three tests facilitates the diagnosis of DKD and assessment of its severity.
作者
刘舒放
李占亭
袁二磊
Liu Shu-fang;Li Zhan-ting;Yuan Er-lei(Department of Nephrology,Xi'an International Medical Centre Hospital,Xi'an 710000,China;Department of Critical Care Medicine,Xi'an International Medical Centre Hospital,Xi'an 710000,China)
出处
《临床肾脏病杂志》
2025年第9期782-789,共8页
Journal of Clinical Nephrology
