老年糖尿病肾病患者血清糖化血红蛋白、IL-6、胱抑素C与肾小球滤过率的相关性分析

王丽之; 黄若妃; 吕美艳; 田园

doi:10.16766/j.cnki.issn.1674-4152.002514

老年糖尿病肾病患者血清糖化血红蛋白、IL-6、胱抑素C与肾小球滤过率的相关性分析

doi: 10.16766/j.cnki.issn.1674-4152.002514

永康市第一人民医院检验科，浙江永康 321300

基金项目:

浙江省医药卫生科技计划项目 2019RC305

详细信息

通讯作者:
王丽之, E-mail: 120372741@qq.com

中图分类号: R587.2 R446
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- 被引次数: 0
出版历程
- 收稿日期: 2022-01-04
- 网络出版日期: 2022-09-21

Correlation analysis of serum glycosylated haemoglobin, interleukin-6 and cystatin C with GFR in elderly patients with diabetic nephropathy

Clinical Laboratory, Yongkang First People's Hospital, Yongkang, Zhejiang 321300, China

摘要

摘要: 目的探讨老年糖尿病肾病患者血清糖化血红蛋白(HbA1c)、白介素(IL)-6以及胱抑素C(CysC)与肾小球滤过率(GFR)的相关性。方法选取永康市第一人民医院2020年1月—2021年6月收治的老年糖尿病肾病患者78例为观察组；同期收治的单纯老年糖尿病患者77例为对照组；同期接受健康体检并证实为健康者80名为健康组。分析3组研究对象HbA1c、IL-6、CysC及GFR，GFR采用肾动态显像法测定；比较观察组患者不同分期各指标水平；进一步分析HbA1c、IL-6、CysC与GFR的相关性。结果观察组患者HbA1c为(8.15±1.94)%，IL-6为(40.37±11.79)ng/L，CysC为(3.25±1.06)mg/L，GFR为(49.64±6.54)mL/min，对照组分别为(7.24±1.15)%、(14.22±6.98)ng/L、(1.52±0.55)mg/L、(103.21±4.85)mL/min，健康组分别为(5.16±0.33)%、(10.70±3.22)ng/L、(0.86±0.22)mg/L、(123.43±3.18)mL/min，观察组患者HbA1c、IL-6及CysC显著高于其他2组，对照组高于健康组，GFR显著低于其他2组，对照组低于健康组，差异均有统计学意义(均P < 0.05)；随着临床分期的增加，患者HbA1c、IL-6及CysC逐渐升高，GFR逐渐降低，组间比较差异均有统计学意义(均P < 0.05)；糖尿病肾病患者HbA1c、IL-6、CysC与GFR呈负相关关系(r=-0.537、-0.838、-0.709，均P < 0.05)。结论糖尿病肾病患者HbA1c、IL-6、CysC与GFR呈负相关，实际临床工作中可以通过测定HbA1c、IL-6、CysC水平评估患者病情。
- 糖尿病肾病 /
- 糖化血红蛋白 /
- 白介素 /
- 胱抑素 /
- 肾小球滤过率 /
- 相关性
Abstract: Objective To investigate the correlation of serum glycosylated haemoglobin (HbA1c), IL-6 and cystatin C (CysC) with the glomerular filtration rate (GFR) in elderly patients with diabetic nephropathy. Methods A total of 78 elderly patients with diabetic nephropathy who were treated in Yongkang First People's Hospital from January 2020 to June 2021 were selected as the observation group, and 77 elderly patients with simple diabetes who were treated in our hospital during the same period were selected as the control group. During the same period, 80 persons who underwent physical examination and were confirmed to be healthy were regarded as the healthy group. The levels of HbA1c, IL-6 and CysC and GFR were analysed in the three groups. GFR was determined by renal dynamic imaging method. The levels of various indexes in different stages of the observation group were compared. The correlation between the levels of HbA1c, IL-6 and CysC and GFR was further analysed. Results In the observation group, the HbA1c, IL-6, CysC and GFR were (8.15±1.94) %, (40.37±11.79) ng/L, (3.25±1.06) mg/L, (49.64±6.54) mL/min, respectively. In the control group, the HbA1c, IL-6, CysC and GFR were (7.24±1.15) %, (14.22±65.98) ng/L, (1.52±0.55) mg/L, (103.21±4.85) mL/min, respectively. In the healthy group, the HbA1c, IL-6, CysC and GFR were (5.16±0.33) %, (10.70±3.22) ng/L and (0.86±0.22) mg/L, (123.43±3.18) mL/min, respectively. The levels of HbA1c, IL-6 and CysC in the observation group were significantly higher than those in the other two groups. The levels of these indexes in the control group were higher than those in the healthy group (P < 0.05). The GFR in the observation group was significantly lower than those in the other two groups (P < 0.05). The GFR in the control group was lower than that in the healthy group (P < 0.05). With the increase of clinical stage, the levels of HbA1c, IL-6 and CysC gradually increased, and the GFR gradually decreased, and the differences between groups were statistically significant (all P < 0.05). The levels of HbA1c, IL-6 and CysC were negatively correlated with GFR levels in patients with diabetic nephropathy (r=-0.537, -0.838, -0.709, all P < 0.05). Conclusion The levels of HbA1c, IL-6 and CysC in patients with diabetic nephropathy are negatively correlated with the level of GFR. In clinical work, the levels of HbA1c, IL-6 and CysC can be measured to evaluate the patient's condition.
- Diabetic nephropathy /
- Glycosylated haemoglobin /
- Interleukin /
- Cystatin /
- Glomerular filtration rate /
- Correlation

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表 1 3组研究对象一般资料比较

Table 1. Comparison of general information of the 3 groups of study subjects

组别	例数	性别(例)		年龄 (x±s，岁)	体重 (x±s，kg)
组别	例数	男性	女性	年龄 (x±s，岁)	体重 (x±s，kg)
观察组	78	41	37	69.93±3.41	67.01±3.88
对照组	77	40	37	69.52±3.74	67.31±4.05
健康组	80	44	36	68.95±3.72	66.48±3.02
统计量		0.165^a		1.461^b	1.032^b
P值		0.921		0.235	0.358
注：^a为χ²值，^b为F值。

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表 2 3组研究对象各指标比较(x±s)

Table 2. Comparison of indicators among the 3 groups of study subjects(x±s)

组别	例数	HbA1c(%)	IL-6(ng/L)	CysC(mg/L)	GFR(mL/min)
观察组	78	8.15±1.94	40.37±11.79	3.25±1.06	49.64±6.54
对照组	77	7.24±1.15^a	14.22±6.98^a	1.52±0.55^a	103.21±4.85^a
健康组	80	5.16±0.33^ab	10.70±3.22^ab	0.86±0.22^ab	123.43±3.18^ab
F值		97.285	313.723	233.185	4 617.826
P值		< 0.001	< 0.001	< 0.001	< 0.001
注：与观察组比较，^aP < 0.05；与对照组比较，^bP < 0.05。

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表 3 观察组不同分期患者各指标比较(x±s)

Table 3. Comparison of various indicators among patients with different stages in the observation group(x±s)

组别	例数	HbA1c(%)	IL-6(ng/L)	CysC(mg/L)	GFR(mL/min)
Ⅰ期	10	6.54±0.65	15.64±5.37	1.72±0.29	110.31±5.26
Ⅱ期	17	7.05±0.75^a	22.01±5.81^a	2.01±0.40^a	69.98±7.92^a
Ⅲ期	18	8.11±1.01^ab	36.93±7.31^ab	2.53±0.46^ab	43.98±1.83^ab
Ⅳ期	14	8.23±1.13^abc	44.91±8.52^abc	3.11±0.56^abc	18.25±3.72^abc
Ⅴ期	19	9.05±1.74^abcd	59.11±10.02^abcd	3.61±0.82^abcd	7.75±1.47^abcd
F值		10.485	75.714	28.665	1 070.570
P值		< 0.001	< 0.001	< 0.001	< 0.001
注：与Ⅰ期比较，^aP < 0.05；与Ⅱ期比较，^bP < 0.05；与Ⅲ期比较，^cP < 0.05；与Ⅳ期比较，^dP < 0.05。

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表 4 观察组患者各指标与GFR水平的相关性分析

Table 4. Correlation analysis of each index and GFR level in the observation group

项目	r值	P值
HbA1c	-0.537	< 0.001
IL-6	-0.838	< 0.001
CysC	-0.709	< 0.001

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参考文献(18)

[1]	郑海瑞, 贾卫国, 王国强, 等. SRT2104对小鼠糖尿病肾病发病机制及SIRT1/P53/NRF2通路的影响[J]. 临床和实验医学杂志, 2019, 18(16): 1713-1716. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLC201916010.htm ZHENG H R, JIA W G, WANG G Q, et al. Effect of SRT2104 on pathogenesis of diabetic nephropathy and the SIRT1/P53/NRF2 pathway[J]. Journal of Clinical and Experimental Medicine, 2019, 18(16): 1713-1716. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLC201916010.htm
[2]	LENZI S, GIAMPIETRO O, GIOWANNITTI G, et al. The clinical usefulness of glycated hemoglobin in monitoring diabetes mellitus: A long-term study[J]. Clin Chem, 2020, 15(1): 1.
[3]	邵长娟, 沈萌, 孙丽丽. 血清IL-6、TNF-α、超敏C反应蛋白在糖尿病肾病患者中的水平变化及意义[J]. 中国卫生工程学, 2020, 19(3): 444-446. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWX202003052.htm SHAO C J, SHEN M, SUN L L. Changes in the levels of serum IL-6, TNF-α and ultrasensitive C-reactive protein in patients with diabetic nephropathy and their significance[J]. Chinese Journal of Public Health Engineering, 2020, 19(3): 444-446. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWX202003052.htm
[4]	肖卿玉, 吴海军, 成珍, 等. 抗中性粒细胞胞质抗体联合相关炎症因子检测对糖尿病肾病的诊断价值[J]. 国际泌尿系统杂志, 2020, 40(4): 693-696. doi: 10.3760/cma.j.cn431460-20190418-00033 XIAO Q Y, WU H J, CHEN Z, et al. Diagnostic value of detection of antineutrophil cytoplasmic antibody combined with related inflammatory factors in diabetic nephropathy[J]. International Journal of Urology and Nephrology, 2020, 40(4): 693-696. doi: 10.3760/cma.j.cn431460-20190418-00033
[5]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志, 2018, 10(1): 4-67. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201804009.htm Chinese Medical Association Diabetic Society. Guidelines for the prevention and treatment of type 2 diabetes in China (2017 edition)[J]. Chinese Journal Of Diabetes Mellitus, 2018, 10(1): 4-67. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201804009.htm
[6]	中华医学会糖尿病学分会微血管并发症学组. 糖尿病肾病防治专家共识(2014年版)[J]. 中华糖尿病杂志, 2014, 6(11): 792-801. doi: 10.3760/cma.j.issn.1674-5809.2014.11.004 Microvascular Complications Group of the Chinese Medical Association Diabetes Branch. Expert consensus on the management of diabetic nephropathy (2014 edition)[J]. Chinese Journal Of Diabetes Mellitus, 2014, 6(11): 792-801. doi: 10.3760/cma.j.issn.1674-5809.2014.11.004
[7]	应一樱, 陈洁, 包蓓艳. 维生素D联合西格列汀对2型糖尿病肾病患者尿蛋白水平、骨密度和骨代谢的影响[J]. 中华全科医学, 2019, 17(5): 797-800, 840. doi: 10.16766/j.cnki.issn.1674-4152.000795 YING Y Y, CHEN J, BAO B Y. Effects of vitamin D combined with siglitatin on urinary protein level, bone mineral density and bone metabolism in patients with type 2 diabetic nephropathy[J]. Chinese Journal of General Practice, 2019, 17(5): 797-800, 840. doi: 10.16766/j.cnki.issn.1674-4152.000795
[8]	薛耀明. 重视糖尿病肾脏病患者的心血管风险评估与管理[J]. 中华糖尿病杂志, 2020, 12(10): 761-764. doi: 10.3760/cma.j.cn115791-20200831-00543 XUE Y M. Assessment and management of cardiovascular risk in patients with diabetic kidney disease[J]. Chinese Journal Of Diabetes Mellitus, 2020, 12(10): 761-764. doi: 10.3760/cma.j.cn115791-20200831-00543
[9]	王力. 糖尿病肾病患者微炎症状态与营养不良的相关性研究[J]. 内科急危重症杂志, 2018, 24(3): 223-225, 258. https://www.cnki.com.cn/Article/CJFDTOTAL-NKJW201803015.htm WANG L. Relationship between microinflammatory status and malnutrition in patients with diabetic nephropathy[J]. Journal of Critical Care in Internal Medicine, 2018, 24(3): 223-225, 258. https://www.cnki.com.cn/Article/CJFDTOTAL-NKJW201803015.htm
[10]	孙冠媛, 于辉田, 宁宁, 等. 不同剂量阿托伐他汀对糖尿病肾病患者免疫及全身微炎症状态的影响[J]. 实用药物与临床, 2019, 22(7): 693-696. https://www.cnki.com.cn/Article/CJFDTOTAL-LYLC201907005.htm SUN G Y, YU H T, NING N, et al. Effects of different doses of atorvastatin on immune and systemic inflammatory state in patients with diabetic nephropathy[J]. Practical Pharmacy and Clinical Remedies, 2019, 22(7): 693-696. https://www.cnki.com.cn/Article/CJFDTOTAL-LYLC201907005.htm
[11]	ABDELRAHMAN A M, SULEIMANI Y A, SHALABY A, et al. Effect of tocilizumab, an interleukin-6 inhibitor, on early stage streptozotocin-in- duced diabetic nephropathy in rats[J]. Naunyn Schmiedebergs Arch Pharmakol, 2019, 392(8): 1005-1013. doi: 10.1007/s00210-019-01655-w
[12]	王世英, 赵欣欣, 时军, 等. AMPK过表达抑制姥鲛烷诱导的狼疮鼠中肾小球系膜细胞增生和基质合成及炎症反应[J]. 细胞与分子免疫学杂志, 2017, 33(11): 1479-1485. https://www.cnki.com.cn/Article/CJFDTOTAL-XBFM201711008.htm WANG S Y, ZHAO X X, SHI J, et al. AMPK over-expression inhibits proliferation, matrix synthesis and inflammation response of glomerular mesangial cells in pristine-induced lupus mice[J]. Chinese Journal of Cellular and Molecular Immunology, 2017, 33(11): 1479-1485. https://www.cnki.com.cn/Article/CJFDTOTAL-XBFM201711008.htm
[13]	胡纯, 吴小燕. 糖尿病肾病炎症发生机制及治疗研究进展[J]. 重庆医科大学学报, 2021, 46(5): 618-624. https://www.cnki.com.cn/Article/CJFDTOTAL-ZQYK202105024.htm HU C, WU X Y. Study progress on pathogenesis and treatments of inflammation in diabetic kidney disease[J]. Journal of Chongqing Medical University, 2021, 46(5): 618-624. https://www.cnki.com.cn/Article/CJFDTOTAL-ZQYK202105024.htm
[14]	宋明爱, 王璐. 糖尿病肾病血液透析患者血清氨甲酰血红蛋白、糖化血红蛋白含量检测及其临床价值评估[J]. 海南医学院学报, 2016, 22(12): 1296-1299. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYY201612033.htm SONG M A, WANG L. Clinical value of serum carbaminohemoglobin and glycated hemoglobin contents in diabetic nephropathy patients with hemodialysis[J]. Journal of Hainan Medical University, 2016, 22(12): 1296-1299. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYY201612033.htm
[15]	WANG N, XU Z, HAN P, et al. Glycated albumin and ratio of glycated albumin to hemoglobin are good indicators of diabetic nephropathy in type 2 diabetes mellitus[J]. Diabetes Metab Res Rev, 2016, 33(2): 2843-2851.
[16]	尚源融, 徐家云, 尚向娜. 当归补血汤联合贝那普利对糖尿病肾病患者肾功能及RBP4、HbA1C含量变化的影响[J]. 中医药信息, 2020, 37(3): 88-91. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXN202003020.htm SHANG Y R, XU J Y, SHANG X N. Effects of Danggui Buxue Decoction and Benazepril on Renal Function, RBP4 and HbA1C in DN Patients[J]. Information on Traditional Chinese Medicine, 2020, 37(3): 88-91. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXN202003020.htm
[17]	张关亭. CysC、β2微球蛋白、肌酐、尿素氮在2型糖尿病肾病不同阶段的水平变化及诊断价值[J]. 中华全科医学, 2017, 15(5): 850-852. doi: 10.16766/j.cnki.issn.1674-4152.2017.05.037 ZHANG G T. Change of cystatin C, β2-microglobulin, creatinine and blood urea nitrogen in different stages of type 2 diabetic nephropathy and their diagnostic value[J]. Chinese Journal of General Practice, 2017, 15(5): 850-852. doi: 10.16766/j.cnki.issn.1674-4152.2017.05.037
[18]	冯雪凤, 李爱梅, 许守林, 等. 肾小球滤过率、尿微量白蛋白、血β2-微球蛋白和胱抑素C诊断糖尿病肾病的临床价值[J]. 中华核医学与分子影像杂志, 2017, 37(6): 331-336. FENG X F, LI A M, XU S L, et al. Diagnostic value of glomerular filtration rate, microalbuminuria, β2-microglobulin and cystatin C for renal function in patients with diabetic nephropathy[J]. Chinese Journal of Nuclear Medicine, 2017, 37(6): 331-336.