Li Hui, Gao Fang, Xue Yaoming, Qian Yi
Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. E-mail:
Nan Fang Yi Ke Da Xue Xue Bao. 2014 Mar;34(3):387-90.
To detect the plasma level of growth differentiation factor-15 (GDF-15) in patients of type 2 diabetic nephropathy and assess its value in diagnosis and evaluation of type 2 diabetic nephropathy.
Thirty type 2 diabetic patients with normoalbuminuria, 20 with microalbuminuria, and 30 with macroalbuminuria, diagnosed according to Mogensen's criteria, were examined for plasma GDF-15 level using enzyme-linked immunosorbent assay.
The patients with macroalbuminuria had significantly higher plasma GDF-15 level than those with microalbuminuria and normoalbuminuria [1773.9 (1099.1-2357.4) pg/ml vs 864.0 (636.1-994.3) pg/ml and 704.5 (548.8-975.8) pg/ml, respectively, P<0.01], and patients with microalbuminuria had higher GDF-15 level than those with normoalbuminuria (P>0.05). Plasma GDF-15 level was found to increase early in the stage of mild renal dysfunction (60≤GFR<90 ml·min(-1)·1.73 m(-2)) with a median level of 999.5 (769.2-1372.1) pg/ml. Partial correlation analysis showed that plasma GDF-15 level was positively correlated with diabetic durations, mAlb, BUN and sCr (r=0.246, 0.493, 0.390, and 0.471, respectively, P<0.05), and negatively with eGFR (r=-0.438) and Alb (r=-0.397) (P<0.01). Multivariate linear regression analysis showed that a high plasma GDF-15 level was an independent risk factor for increased mAlb. In the diagnosis of renal dysfunction (eGFR<90 ml·min(-1)·1.73 m(-2)), the area under the receiver-operating characteristic curve (AUC) of GDF-15 was 0.801, significantly higher than that of mAlb (0.717, P<0.05). With the cut-off value of 733.78 pg/ml, plasma GDF-15 level had a sensitivity of 88.1% and a specificity of 58.1% for renal dysfunction diagnosis.
In patients with type 2 diabetic nephropathy, plasma GDF-15 level increases with the Mogensen stage, and as a independent risk factor for increased mAlb, it is significantly correlated with mAlb and eGFR, and serves, suggesting its value in early diagnosis, evaluation and prediction of the outcomes of type 2 diabetic nephropathy.
检测2型糖尿病肾病患者血浆生长分化因子15（GDF-15）水平，评估其在2型糖尿病肾病诊断及病情评估中的价值。
按照莫根森（Mogensen）标准诊断的30例正常白蛋白尿2型糖尿病患者、20例微量白蛋白尿患者和30例大量白蛋白尿患者，采用酶联免疫吸附测定法检测血浆GDF-15水平。
大量白蛋白尿患者血浆GDF-15水平显著高于微量白蛋白尿患者和正常白蛋白尿患者[分别为1773.9（1099.1 - 2357.4）pg/ml、864.0（636.1 - 994.3）pg/ml和704.5（548.8 - 975.8）pg/ml，P<0.01]，微量白蛋白尿患者GDF-15水平高于正常白蛋白尿患者（P>0.05）。发现在轻度肾功能不全阶段（60≤肾小球滤过率<90 ml·min⁻¹·1.73 m⁻²）血浆GDF-15水平早期升高，中位数水平为999.5（769.2 - 1372.1）pg/ml。偏相关分析显示血浆GDF-15水平与糖尿病病程、微量白蛋白、血尿素氮和血肌酐呈正相关（r分别为0.246、0.493、0.390和0.471，P<0.05），与估算肾小球滤过率（eGFR）和白蛋白呈负相关（r分别为 - 0.438和 - 0.397）（P<0.01）。多因素线性回归分析显示血浆GDF-15水平升高是微量白蛋白增加的独立危险因素。在肾功能不全（eGFR<90 ml·min⁻¹·1.73 m⁻²）诊断中，GDF-15的受试者工作特征曲线下面积（AUC）为0.801，显著高于微量白蛋白（0.717，P<0.05）。以733.78 pg/ml为临界值，血浆GDF-15水平对肾功能不全诊断的灵敏度为88.1%，特异度为58.1%。
在2型糖尿病肾病患者中，血浆GDF-15水平随莫根森分期升高，作为微量白蛋白增加的独立危险因素，与微量白蛋白和eGFR显著相关，提示其在2型糖尿病肾病早期诊断、病情评估及预后预测中的价值。
