摘要
目的探讨分析肿瘤坏死因子α(TNF-α)与糖尿病肾病病理分期、心血管事件的关系。方法选取212例糖尿病肾病患者作为研究对象,按照病理分期分为典型糖尿病肾小球病(DG)和非典型糖尿病相关肾病(ADRD)两组,分析比较两组临床指标,采用ROC分析TNF-α对糖尿病肾病病理分期的诊断价值,Kalplan-Meier法分析心血管终点事件累积风险因素。结果 DG组在病程、HbA1c、HOMA-IR、TC、LDL-C、hs-CRP、TNF-α、eGFR、β2-MG、BUN及Cys-C方面与ADRD组比较,差异有统计学意义(P <0.05)。TNF-α诊断糖尿病肾病不同病理分期的曲线下面积为0.830(95%CI:0.749～0.913),诊断的最佳临界值为36.0 mmol/L。TNF-α> 36.0 mmol/L组全因死亡、MACE累积风险比率显著高于TNF-α≤36.0 mmol/L组(Log rankχ2=5.427,P=0.027;Log rankχ2=5.014,P=0.029)。多因素回归分析显示,病程(OR=1.766,95%CI:1.043～6.223,P <0.01),HbA1c(OR=1.826,95%CI:1.076～5.444,P <0.05),hs-CRP(OR=2.117,95%CI:1.572～8.336,P <0.01),TNF-α(OR=2.909,95%CI:1.866～6.224,P <0.05),eGFR(OR=1.776,95%CI:1.063～5.023,P <0.05),Cys-C(OR=2.446,95%CI:1.338～7.061,P <0.05)为糖尿病肾病的危险因素。结论 TNF-α高于36.0 mmol/L时对糖尿病肾病病理分期、心血管终点事件有较高的诊断价值,临床值得进一步研究。
Objective To investigate the relationship between tumor necrosis factorαand the pathological stage and cardiovascular events of diabetic nephropathy.Methods 212 patients with diabetic nephropathy were selected as the study subjects.According to the pathological stage,the patients were divided into two groups:typical diabetic glomerulopathy(DG group)and atypical diabetic-related nephropathy(ADRD group).The predictive value of tumor necrosis factor alpha on pathological staging and cardiovascular events of diabetic nephropathy was analyzed and compared.Results The differences in the course of disease,HbA1c,HOMA-IR,TC,LDL-C,hs-CRP,TNF-α,eGFR,β2-MG,BUN and Cys-C were significantly different between the DG group and the ADRD group(P<0.05).The cumulative risk of all-cause mortality and MACE in TNF-α >36.0 mmol/L group was significantly higher than that in TNF-α≤36.0 mmol/L group(P<0.05).Multivariate regression analysis showed that TNF-α(OR=2.909,95%CI:1.866~6.224,P<0.05)was a risk factor for diabetic nephropathy.Conclusion When TNF-αis higher than 36.0 mmol/L,it has higher diagnostic value for diabetic nephropathy pathological stage,cardiovascular end point event,and it deserves further study.
作者
王念鸿
聂庆东
李英姿
宫京梅
张文江
WANG Nianhong;NIE Qingdong;LI Yingzi;GONG Jingmei;ZHANG Wenjiang(Departmenf of Medicine,Tsinghua University Hospital,Beijing 100084,China)
出处
《实用医学杂志》
CAS
北大核心
2019年第2期261-265,270,共6页
The Journal of Practical Medicine
关键词
糖尿病肾病
病理分期
心血管事件
肿瘤坏死因子Α
预后
diabetic nephropathy
pathological stage
cardiovascular events
tumor necrosis factorα
prognosis
