Zhang Zheng, Qian Xiang, Sun Ziwei, Cheng Chen, Gu Min
Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China.
Heliyon. 2024 Aug 6;10(16):e35635. doi: 10.1016/j.heliyon.2024.e35635. eCollection 2024 Aug 30.
This study aimed to analyse the association between lipoprotein-associated phospholipase A2 (Lp-PLA2) and 25-hydroxy-vitamin D (25[OH]D) and early diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM) and evaluate the potential roles of these two biomarkers in the clinical diagnosis of DKD.
A total of 422 inpatients with T2DM were retrospectively enrolled between January 2018 and March 2022 at the First Affiliated Hospital of Nanjing Medical University. The baseline clinical parameters of each patient were determined, and their demographic characteristics were extracted from the hospital information system. The patients were separated into groups according to serum Lp-PLA2 and 25(OH)D levels and binary logistic regression analysis was used to determine independent predictors of early DKD incidence.
Levels of Lp-PLA2 significantly increased and those of 25(OH)D significantly decreased with DKD progression (both < 0.001). Lp-PLA2 concentrations were positively correlated with albuminuria levels (r = 0.37, < 0.001), whereas 25(OH)D levels were negatively correlation (r = -0.34, < 0.001). The incidence of DKD was higher in the Lp-PLA2 elevated and 25(OH)D deficient groups (all < 0.001). Body mass index, systemic immune-inflammatory index, serum uric acid, C-peptide, and triglyceride-glucose indices were positively associated with Lp-PLA2 levels (all < 0.001) and negatively associated with 25(OH)D (all < 0.05). Furthermore, Lp-PLA2 was an independent risk factor ( = 1.003, = 0.015), and 25(OH)D was an independent protective factor ( = 0.937, = 0.008) for early DKD occurrence in binary logistic regression analysis. The area under the curve for the combination of Lp-PLA2 and 25(OH)D for diagnosing DKD was 0.867, with a sensitivity of 70.4 % and a specificity of 89.5 %.
Increased serum Lp-PLA2 and decreased 25(OH)D levels are risk factors for early DKD in patients with T2DM. The combined detection of Lp-PLA2 and 25(OH)D may enhance the diagnostic efficacy of DKD.
本研究旨在分析2型糖尿病（T2DM）患者中脂蛋白相关磷脂酶A2（Lp-PLA2）与25-羟基维生素D（25[OH]D）和早期糖尿病肾病（DKD）之间的关联，并评估这两种生物标志物在DKD临床诊断中的潜在作用。
回顾性纳入2018年1月至2022年3月在南京医科大学第一附属医院住院的422例T2DM患者。测定每位患者的基线临床参数，并从医院信息系统中提取其人口统计学特征。根据血清Lp-PLA2和25(OH)D水平将患者分组，采用二元逻辑回归分析确定早期DKD发病的独立预测因素。
随着DKD进展，Lp-PLA2水平显著升高，25(OH)D水平显著降低（均P<0.001）。Lp-PLA2浓度与蛋白尿水平呈正相关（r=0.37，P<0.001），而25(OH)D水平呈负相关（r=-0.34，P<0.001）。Lp-PLA2升高和25(OH)D缺乏组的DKD发病率更高（均P<0.001）。体重指数、全身免疫炎症指数、血清尿酸、C肽和甘油三酯-葡萄糖指数与Lp-PLA2水平呈正相关（均P<0.001），与25(OH)D呈负相关（均P<0.05）。此外，在二元逻辑回归分析中，Lp-PLA2是早期DKD发生的独立危险因素（OR=1.003，P=0.015），25(OH)D是独立保护因素（OR=0.937，P=0.008）。Lp-PLA2和25(OH)D联合诊断DKD的曲线下面积为0.867，敏感性为70.4%，特异性为89.5%。
血清Lp-PLA2升高和25(OH)D水平降低是T2DM患者早期DKD的危险因素。联合检测Lp-PLA2和25(OH)D可能提高DKD的诊断效能。
