Laboratory Department of Tianjin Third Central Hospital, Tianjin, China.
Experimental Center of Clinical Medical College of Tianjin Medical University, Tianjin, China.
Ann Med. 2023;55(2):2230446. doi: 10.1080/07853890.2023.2230446.
The aim of this study was to investigate diagnosis of lipoprotein-associated phospholipase A2 (Lp-PLA2) in early diabetic nephropathy (DN).
A total of 342 type 2 diabetes mellitus (T2DM) patients hospitalized in department of metabolism and nephrology in our hospital from January 2019 to December 2019 were randomly selected. Patients were divided into three groups via urine albumin level: diabetes mellitus (DM) group, simple diabetes group (114 patients, urinary albumin creatinine ratio (UACR) < 30 mg/g); DN1 group, early DN group (114 patients, UACR: 30-300 mg/g); DN2 group: clinical DN group (114 patients, UACR > 300mg/g). Eighty healthy adults were examined at the same time. Lp-PLA2, fasting blood glucose (FBG), creatinine (Cr), triglyceride (TG), total cholesterol (TCHOL), high-density lipoprotein (HDL), low-density lipoprotein (LDL), haemoglobin A1c (HbA1c), blood urea nitrogen/creatinine (BUN/Cr), estimated glomerular filtration rate (eGFR), 24-h urine protein, albumin and creatinine of all subjects were detected and compared. Pearson's correlation analysis and multiple ordered logistic regression were used to investigate the correlation between serum Lp-PLA2 level and DN. The possibility of Lp-PLA2 in the diagnosis of early DN was studied by using the subject working curve.
Lp-PLA2 level in DN1 and DN2 groups was significantly higher than that in DM group, with statistical difference ( < .05). With the progression of DN, the level of Lp-PLA2 gradually increased < .05. Lp-PLA2 was positively correlated with FBG, TG, LDL and HbA1c ( = 0.637, < .01; = 0.314, = .01; = 0.213, = .01; = 0.661, ≤ .01), was negatively correlated with HDL ( = -0.230, < .01). The results showed that Lp-PLA2 was an independent factor in the evaluation of early DN. The area under the curve for the evaluation of serum Lp-PLA2 level in early DN was 0.841, the optimal critical value was 155.9 ng/mL, the sensitivity was 88% and the specificity was 76.2%.
Lp-PLA2 is an independent factor for the evaluation of early DN, and can be used as an important potential specific indicator for the diagnosis of early DN, meanwhile monitoring the progression of DN.
本研究旨在探讨脂蛋白相关磷脂酶 A2（Lp-PLA2）在早期糖尿病肾病（DN）中的诊断价值。
选取 2019 年 1 月至 12 月在我院代谢肾病科住院的 342 例 2 型糖尿病（T2DM）患者，根据尿白蛋白水平将患者分为 3 组：糖尿病组（DM 组，114 例，尿白蛋白肌酐比（UACR）<30 mg/g）、单纯糖尿病组（114 例，UACR：30-300 mg/g）、DN1 组；DN2 组：临床 DN 组（114 例，UACR>300mg/g）。同时检测 80 名健康成年人的 Lp-PLA2、空腹血糖（FBG）、肌酐（Cr）、甘油三酯（TG）、总胆固醇（TCHOL）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、糖化血红蛋白 A1c（HbA1c）、血尿素氮/肌酐（BUN/Cr）、估算肾小球滤过率（eGFR）、24 小时尿蛋白、白蛋白和肌酐。采用 Pearson 相关分析和多因素有序 logistic 回归分析探讨血清 Lp-PLA2 水平与 DN 的相关性。采用受试者工作曲线研究 Lp-PLA2 在早期 DN 诊断中的可能性。
DN1 组和 DN2 组的 Lp-PLA2 水平明显高于 DM 组，差异有统计学意义（<0.05）。随着 DN 的进展，Lp-PLA2 水平逐渐升高（<0.05）。Lp-PLA2 与 FBG、TG、LDL 和 HbA1c 呈正相关（=0.637，<0.01；=0.314，=0.01；=0.213，=0.01；=0.661，<0.01），与 HDL 呈负相关（=−0.230，<0.01）。结果表明，Lp-PLA2 是早期 DN 评价的独立因素。血清 Lp-PLA2 水平评估早期 DN 的曲线下面积为 0.841，最佳临界值为 155.9 ng/mL，灵敏度为 88%，特异性为 76.2%。
Lp-PLA2 是早期 DN 评价的独立因素，可作为早期 DN 诊断的重要潜在特异性指标，并可监测 DN 的进展。
