ESM-1和PTX3对老年糖尿病肾病患者并发肺部感染的诊断价值

王小华; 王钧; 李莉; 高倩

doi:10.16766/j.cnki.issn.1674-4152.004127

ESM-1和PTX3对老年糖尿病肾病患者并发肺部感染的诊断价值

doi: 10.16766/j.cnki.issn.1674-4152.004127

绍兴文理学院附属医院老年医学科，浙江绍兴 312000

基金项目:

浙江省医药卫生科技计划项目 2024KY1739

详细信息

通讯作者:
王钧，E-mail：641547704@qq.com

中图分类号: R587.2 R563.1
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出版历程
- 收稿日期: 2025-01-09
- 网络出版日期: 2025-10-31

Diagnostic value of ESM-1 and PTX3 in elderly patients with diabetic nephropathy complicated with pulmonary infection

Department of Geriatrics, Affiliated Hospital of Shaoxing University of Arts and Sciences, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的分析内皮细胞特异性分子-1(ESM-1)、正五聚蛋白3(PTX3)对老年糖尿病肾病(DN)患者并发肺部感染的诊断价值，为改善患者预后提供更多有价值的预测指标。方法选取绍兴文理学院附属医院2020年10月—2023年10月收治的81例DN患者，根据是否并发肺部感染分为DN并发肺部感染组(36例)和DN组(45例)，检测患者血清ESM-1、PTX3水平，绘制ROC曲线以评估ESM-1、PTX3对老年DN患者并发肺部感染的诊断价值。结果 DN并发肺部感染组血清ESM-1水平为(5.64±1.24)ng/mL、PTX3水平为(203.57±44.86)ng/mL，均高于DN组的(3.91±1.11)ng/mL、(148.44±39.95)ng/mL(t=6.616、5.843，P＜0.001)；多因素logistic回归分析结果显示，长DM病程、高空腹血糖水平、低血清白蛋白水平、高糖化血红蛋白(HbA1c)值、有COPD病史、进行维持性血液透析、肾功能处于失代偿期及高ESM-1水平、高PTX3水平均是影响老年DN患者并发肺部感染的独立危险因素(P<0.05)；ROC曲线分析结果显示，ESM-1、PTX3诊断老年DN患者并发肺部感染的AUC分别为0.834、0.862，二者联合诊断的AUC为0.929。结论老年DN并发肺部感染患者血清ESM-1、PTX3水平明显升高，检测二者水平有助于诊断老年DN并发肺部感染。
- 糖尿病肾病 /
- 肺部感染 /
- 内皮细胞特异性分子-1 /
- 长正五聚蛋白3 /
- 诊断价值
Abstract: Objective To analyze the diagnostic value of endothelium-specific molecule-1 (ESM-1) and pentamerin-3 (PTX3) in elderly patients with diabetic nephropathy (DN) complicated with pulmonary infection, and to provide more valuable prognostic indicators for the improvement of patient prognosis. Methods A total of 81 patients with DN admitted to the Affiliated Hospital of Shaoxing University of Arts and Sciences from October 2020 to October 2023 were selected and divided into DN group with pulmonary infection (n=36) and DN group (n=45) according to whether they had pulmonary infection. Serum ESM-1 and PTX3 levels of the patients were detected. ROC curve was drawn to evaluate the diagnostic value of ESM-1 and PTX3 in elderly patients with DN complicated with pulmonary infection. Results The levels of serum ESM-1 and PTX3 were (5.64±1.24) ng/mL and (203.57±44.86) ng/mL in the DN group complicated with pulmonary infection. They were higher than those in DN group [(3.91±1.11) ng/mL, (148.44±39.95) ng/mL, t=6.616, 5.843, P<0.001]. The results of multivariate logistic regression analysis showed that long duration of DM, high fasting blood glucose level, low serum albumin level, high HbA1c value, history of COPD, maintenance hemodialysis, renal decompensation, high ESM-1 level and high PTX3 level were independent risk factors for pulmonary infection in elderly patients with DN (P<0.05). ROC curve analysis indicated that the AUCs of ESM-1 and PTX3 in the diagnosis of pulmonary infection in elderly DN patients were 0.834 and 0.862 respectively, and the AUC of combined diagnosis was 0.929. Conclusion Serum ESM-1 and PTX3 levels in elderly patients with DN complicated with pulmonary infection are significantly increased. The detection of the two levels is helpful to the diagnosis of pulmonary infection in elderly patients with DN.
- Diabetic nephropathy /
- Pulmonary infection /
- Endothelial cell specific molecule-1 /
- Pentraxins3 /
- Diagnostic value

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图 1 ESM-1、PTX3诊断老年DN患者并发肺部感染的ROC曲线

Figure 1. ROC curve of ESM-1 and PTX3 in diagnosis of pulmonary infection in elderly patients with DN

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表 1 DN组和DN并发肺部感染组患者一般资料比较

Table 1. Comparison of general data between DN group and DN group complicated with pulmonary infection

项目	DN并发肺部感染组(n=36)	DN组 (n=45)	统计量	P值
性别[例(%)]			0.040^a	0.842
男性	20(55.56)	24(53.33)
女性	16(44.44)	21(46.67)
年龄(x±s，岁)	66.84±8.09	65.71±9.37	0.573^b	0.569
体重指数[例(%)]			0.799^a	0.371
＞24	8(22.22)	14(31.11)
≤24	28(77.78)	31(68.89)
DM病程(x±s，年)	11.17±2.31	7.85±2.06	6.829^b	< 0.001
空腹血糖[例(%)]			4.991^a	0.025
≥14 mmol/L	10(27.78)	4(8.89)
＜14 mmol/L	26(72.22)	41(91.11)
血清白蛋白(g/L)			4.506^a	0.034
＜30	14(38.89)	8(17.78)
≥30	22(61.11)	37(82.22)
HbA1c[例(%)]			5.972^a	0.015
＜7%	11(30.56)	26(57.78)
≥7%	25(69.44)	19(42.22)
COPD病史[例(%)]			5.956^a	0.015
有	12(33.33)	5(11.11)
无	24(66.67)	40(88.89)
维持性血液透析[例(%)]			5.363^a	0.021
有	26(72.22)	21(46.67)
无	10(27.78)	24(53.33)
肾功能状况[例(%)]			8.307^a	0.004
代偿期	15(41.67)	33(73.33)
失代偿期	21(58.33)	12(26.67)
注：^a为χ²值，^b为t值。

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表 2 DN组和DN并发肺部感染组患者血清ESM-1、PTX3水平比较(x±s, ng/mL)

Table 2. Comparison of serum ESM-1 and PTX3 levels between DN group and DN group complicated with pulmonary infection(x±s, ng/mL)

组别	例数	ESM-1	PTX3
DN并发肺部感染组	36	5.64±1.24	203.57±44.86
DN组	45	3.91±1.11	148.44±39.95
t值		6.616	5.843
P值		< 0.001	< 0.001

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表 3 老年DN患者并发肺部感染的多因素logistic回归分析

Table 3. Multivariate logistics regression analysis of pulmonary infection in elderly patients with DN

变量	B	SE	Waldχ²	P值	OR值	95% CI
DM病程	0.641	0.206	9.682	0.002	1.898	1.268~2.843
空腹血糖	1.187	0.531	4.997	0.026	3.277	1.157~9.279
血清白蛋白	0.704	0.329	4.579	0.033	2.022	1.061~3.853
HbA1c值	0.683	0.257	7.156	0.024	2.349	1.281~6.349
COPD病史	1.096	0.448	5.985	0.015	2.992	1.243~7.200
维持性血液透析	0.826	0.362	5.206	0.023	2.284	1.124~4.644
肾功能状况	0.998	0.385	6.720	0.010	2.713	1.276~5.770
ESM-1	0.681	0.203	11.254	0.001	1.976	1.327~2.941
PTX3	1.145	0.473	5.860	0.016	3.142	1.243~7.941

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表 4 血清ESM-1、PTX对老年DN患者并发肺部感染的诊断效能比较

Table 4. Diagnostic value of ESM-1 and PTX3 in elderly patients with DN complicated with pulmonary infection

指标	最佳截断值	AUC	95% CI	P值	灵敏度 (%)	特异度 (%)
ESM-1	4.57 ng/mL	0.834	0.746~0.923	< 0.001	80.60	77.80
PTX3	168.89 ng/mL	0.862	0.786~0.938	< 0.001	86.10	73.30
联合诊断		0.929	0.876~0.982	< 0.001	91.70	71.10

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参考文献(22)

[1]	LI X, LU L H, HOU W T, et al. Epigenetics in the pathogenesis of diabetic nephropathy[J]. Acta Biochim Biophys Sin(Shanghai), 2022, 54(2): 163-172.
[2]	李温柳, 邢春燕, 李勤, 等. 雷公藤多苷治疗糖尿病肾病1例及抗炎抗纤维化疗效分析[J]. 中华全科医学, 2024, 22(3): 530-533. doi: 10.16766/j.cnki.issn.1674-4152.003442 LI W L, XING C Y, LI Q, et al. Tripterygium glycosides in the treatment of diabetic nephropathy: a case report and analysis of anti-inflammatory and anti-fibrotic efficacy[J]. Chinese Journal of General Practice, 2024, 22(3): 530-533. doi: 10.16766/j.cnki.issn.1674-4152.003442
[3]	CONSTANTIN L, UNGURIANU A, STREINU-CERCEL A, et al. Investigation of serum endocan levels in SARS-CoV-2 patients[J]. Int J Mol Sci, 2024, 25(5): 3042-3056. doi: 10.3390/ijms25053042
[4]	郭俊, 许强宏. 脓毒症患者血栓调节蛋白和纤溶酶原激活物抑制剂-1及内皮细胞损伤程度的研究初探[J]. 中华内科杂志, 2021, 60(2): 143-146. GUO J, XU Q H. Thrombomodulin, plasminogen activator inhibitor-1, and endothelial injury severity in sepsis patients: a preliminary study[J]. Chinese Journal of Internal Medicine, 2021, 60(2): 143-146.
[5]	KERGET F, KERGET B, KAHRAMAN Ç Y, et al. Evaluation of the relationship between pentraxin 3 (PTX3) rs2305619 (281A/G) and rs1840680 (1449A/G) polymorphisms and the clinical course of COVID-19[J]. J Med Virol, 2021, 93(12): 6653-6659. doi: 10.1002/jmv.27238
[6]	DOBIÁS R, JAWORSKÁ P, SKOPELIDOU V, et al. Distinguishing invasive from chronic pulmonary infections: host pentraxin 3 and fungal siderophores in bronchoalveolar lavage fluids[J]. J Fungi (Basel), 2022, 8(11): 1194-1204.
[7]	中华医学会内分泌学分会. 中国成人糖尿病肾脏病临床诊断的专家共识[J]. 中华内分泌代谢杂志, 2016, 31(10): 379-385. Chinese Society of Endocrinology. Expert consensus on the clinical diagnosis of diabetic kidney disease in chinese adults[J]. Chinese Journal of Endocrinology and Metabolism, 2016, 31(10): 379-385.
[8]	中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 中华医学杂志, 2001, 81(5): 314-320. Ministry of Health of the People's Republic of China. Diagnostic criteria for hospital-acquired infections (trial implementation)[J]. Chinese Medical Journal, 2001, 81(5): 314-320.
[9]	HUREAU M, PORTIER L, PRIN M, et al. Evaluation of endocan as a treatment for acute inflammatory respiratory failure[J]. Cells, 2023, 12(2): 257-268. doi: 10.3390/cells12020257
[10]	GÖRGÜN S, CINDORUK Ş, ÖZGEN E, et al. Diagnostic and prognostic value of serum endocan levels in patients with COVID-19[J]. Angiology, 2021, 72(10): 942-946. doi: 10.1177/00033197211026044
[11]	SHARMA A, AGRAWAL A, SINDHWANI G, et al. Efficacy of procalcitonin and pentraxin-3 as early biomarkers for differential diagnosis of pleural effusions[J]. Pleura Peritoneum, 2021, 6(2): 83-90. doi: 10.1515/pp-2021-0111
[12]	LI J, LI Y, CHAI R F, et al. PTX3 protects intestinal mucosal barrier damage in sepsis through toll-like receptor signaling pathway[J]. Inflammation, 2022, 45(6): 2339-2351. doi: 10.1007/s10753-022-01696-z
[13]	ZHAO C, ZHAO X S, XU L P, et al. Recipient and donor PTX3 rs2305619 polymorphisms increase the susceptibility to invasive fungal disease following haploidentical stem cell transplantation: a prospective study[J]. BMC Infect Dis, 2022, 22(1): 292-302. doi: 10.1186/s12879-022-07298-2
[14]	裴戌锋, 严友纪, 黄芳, 等. 血清ESM-1、VE-Cad、CC16水平与脓毒症并发急性呼吸窘迫综合征患者炎性因子及预后的关系研究[J]. 现代生物医学进展, 2022, 22(13): 2570-2574. PEI X F, YAN Y J, HUANG F, et al. Relationship between serum ESM-1, VE-Cad, CC16 levels and inflammatory factors as well as prognosis in sepsis patients complicated with acute respiratory distress syndrome[J]. Progress in Modern Biomedicine, 2022, 22(13): 2570-2574.
[15]	SHI G Q, YANG L, SHAN L Y, et al. Investigation of the clinical significance of detecting PTX3 for community-acquired pneumonia[J]. Eur Rev Med Pharmacol Sci, 2020, 24(16): 8477-8482.
[16]	杜静, 赵华昌, 李小燕, 等. SM-1、IFN-γ、IL-1β与IL-8对ARDS合并肺部感染及预后的预测价值[J]. 中华医院感染学杂志, 2023, 33(19): 2886-2890. DU J, ZHAO H C, LI X Y, et al. Predictive value of SM-1, IFN-γ, IL-1β, and IL-8 in ARDS complicated with pulmonary infection and prognosis[J]. Chinese Journal of Nosocomiology, 2023, 33(19): 2886-2890.
[17]	田茜, 李宝新, 李娜, 等. 2型糖尿病肾脏病患者血清长正五聚蛋白3和α-klotho蛋白水平的变化及意义[J]. 安徽医学, 2020, 41(8): 900-906. TIAN Q, LI BX, LI N, et al. Changes and clinical significance of serum long pentraxin 3 and alpha-klotho protein levels in patients with type 2 diabetic kidney disease[J]. Anhui Medical Journal, 2020, 41(8): 900-906.
[18]	IN E, KULUÖZTÜRK M, TURGUT T, et al. Endocan as a potential biomarker of disease severity and exacerbations in COPD[J]. Clin Respir J, 2021, 15(4): 445-453. doi: 10.1111/crj.13320
[19]	HE Q, ZHANG M, FENG C L. The role of pentraxin3 in plasma and bronchoalveolar lavage fluid in COPD patients with invasive pulmonary aspergillosis[J]. BMC Pulm Med, 2021, 21(1): 414-419. doi: 10.1186/s12890-021-01793-z
[20]	TANG S C W, YIU W H. Innate immunity in diabetic kidney disease[J]. Nat Rev Nephrol, 2020, 16(4): 206-222. doi: 10.1038/s41581-019-0234-4
[21]	赵自然, 王峥, 董朋涛, 等. Klotho在糖尿病肾病中调控机制研究进展[J]. 中华实用诊断与治疗杂志, 2024, 38(10): 1077-1080. ZHAO Z R, WANG Z, DONG P T, et al. Research Progress on the Regulatory Mechanism of Klotho in Diabetic Nephropathy[J]. Chinese Journal of Practical Diagnosis and Treatment, 2024, 38(10): 1077-1080.
[22]	马婷婷, 刘莉, 徐萍, 等. 达格列净对糖尿病肾病患者肾功能及miR-21-5p和miR-423-5p水平的影响[J]. 中国临床研究, 2024, 37(8): 1219-1223. MA T T, LIU L, XU P, et al. Effects of dapagliflozin on renal function and levels of miR-21-5p and miR-423-5p in patients with diabetic nephropathy[J]. Chinese Clinical Research, 2024, 37(8): 1219-1223