Assessment of urinary NGAL for differential diagnosis and progression of diabetic kidney disease
Assessment of urinary NGAL for differential diagnosis and progression of diabetic kidney disease
复制标题
尿 NGAL 评估用于糖尿病肾病的鉴别诊断和进展。
DOI：
10.1016/j.jdiacomp.2020.107665
复制
发表时间：
2020-10-01
影响因子：
3
通讯作者：
Yuan, Yanggang
中科院分区：
文献类型：
--
作者：
Duan, Suyan;Chen, Jiajia;Yuan, Yanggang
目的：近年来，糖尿病相关的慢性肾脏病（CKD）比肾小球肾炎更常见。鉴于糖尿病肾病（DKD）与非糖尿病肾病（NDKD）的鉴别效率低且困难，以及新出现的证据支持肾小管受累在DKD中的作用，我们旨在研究尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）在DKD与NDKD鉴别诊断和预测价值中的实用性。回顾了2016年6月至2019年8月我中心100例2型糖尿病伴CKD患者的数据。根据肾活检结果将患者分为DKD和NDKD两组。尿NGAL水平通过尿肌酸酐标准化，并计算为uNGAL/肌酸酐比率（uNCR）。采用Logistic回归和受试者工作特征（ROC）曲线分析，探讨DKD发生的独立因素和uNCR的诊断意义。此外，采用Pearson检验和线性回归分析尿蛋白定量与uNCR的关系。Kaplan-Meier生存分析进行评估的前瞻性关联uNCR与肾脏outcome.Results：显著较高的水平，观察到在DKD患者相比，NDKD（28.65 ng/mg与27.47 ng/mg，PB 0.001）。uNCR被确定为糖尿病伴CKD患者发生DKD的独立危险因素（比值比[OR] = 1.020; 95%CI = [1.001-1.399]，p = 0.042）。uNCR预测DKD的最佳临界值为60.685 ng/mg，特异性高（90.5%），但敏感性相对较低（55.7%）。Pearson检验显示，uNCR与蛋白尿、血清肌酸、血尿素氮、糖尿病病程、间质炎症评分和整体硬化呈正相关，而与eGFR、血红蛋白、血清白蛋白和25-羟基维生素D呈负相关。此外，在包括eGFR、血清白蛋白和总胆固醇的完全校正的模型中，uNCR >60.685 ng/mg的组。在Kaplan-Meier生存分析中，uNCR 60.685 ng/mg患者的无事件生存概率显著低于uNCR患者
Objective: Chronic kidney disease (CKD) related to diabetes has become more common than glomerulonephritis in recent years. Given the inefficient and difficult identification of diabetic kidney disease (DKD) from nondiabetic kidney disease (NDKD) as well as a result of emerging evidence supporting a role for tubular involvement in DKD, we aimed to investigate the utility of urinary neutrophil gelatinase-associated lipocalin (uNGAL) in the differential diagnosis and predictive value of DKD from NDKD.Methods: Data for 100 type 2 diabetic patients with CKD at our center from June 2016 to August 2019 were reviewed. All the patients were categorized into 2 groups by the renal biopsy results: DKD and NDKD. Urinary NGAL levels were normalized by urinary creatinine and calculated as uNGAL/creatinine ratios (uNCR). The independent factors of the occurrence of DKD and the diagnostic implications of uNCR were explored by logistic regression and receiver-operating characteristic (ROC) curve analysis. In addition, we analyzed the relationship between uNCR and proteinuria in patients with DKD by Pearson test and linear regression. Kaplan-Meier survival analysis was performed to assess the prospective association of uNCR with the renal outcome.Results: Significantly higher levels of uNCR were observed in patients with DKD when compared to those with NDKD (28.65 ng/mg vs 27.47 ng/mg, pb .001). uNCR was identified as an independent risk factor for the occurrence of DKD in diabetic patients with CKD (odds ratio [OR] = 1.020; 95%CI = [1.001-1.399], p = .042). The optimal cutoff value of uNCR for predicting DKD was 60.685 ng/mg with high specificity (90.5%) but relatively low sensitivity (55.7%). In Pearson test, uNCR was positively correlated with proteinuria, serum creatine, blood urea nitrogen, duration of diabetes, interstitial inflammation score and global sclerosis, whereas it was inversely correlated with eGFR, hemoglobin, serum albumin and 25-hydroxy vitamin D. Furthermore, in a fully adjusted model including eGFR, serum albumin and total cholesterol, the group with uNCR >60.685 ng/mg. In the Kaplan-Meier survival analysis, the event-free survival probability in patients with uNCR 60.685 ng/mg was significantly lower than those with uNCR