Cao Lan-Fang, Xu Qing-Bo, Yang Li
Department of Endocrinology, Jiangxi Provincial Children's Hospital/The Affiliated Children's Hospital of Nanchang Medical College, Nanchang 330038, Jiangxi Province, China.
World J Diabetes. 2025 May 15;16(5):104482. doi: 10.4239/wjd.v16.i5.104482.
BACKGROUND: Early kidney damage is a significant complication in children with newly diagnosed type 1 diabetes mellitus (T1DM). Systemic inflammation plays a key role in the development of diabetic nephropathy. Several inflammatory markers, including the systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), have been proposed as potential indicators of diabetic complications. AIM: To investigate the association between SII, NLR, PLR, and early kidney damage in newly diagnosed T1DM children without pre-existing albuminuria, assessing their utility as predictive biomarkers. METHODS: A longitudinal cohort study was conducted on 102 children aged 3-18 years with newly diagnosed T1DM [baseline urinary albumin-to-creatinine ratio (UACR) < 30 mg/g] recruited between January 2020 and June 2023. Participants were followed biannually for up to three years. Demographic, clinical, and laboratory data, including inflammatory markers (SII, NLR, PLR), were collected at baseline and follow-up. Logistic regression and receiver operating characteristic analyses were used to evaluate the predictive utility of these markers for early kidney damage, defined as UACR ≥ 30 mg/g. RESULTS: SII emerged as a significant independent predictor of early kidney damage [odds ratio = 1.002, 95% confidence interval (CI): 1.0008-1.0033, = 0.0016], with an area under the curve of 0.719 (95%CI: 0.612-0.826, < 0.001). Using an SII threshold of ≥ 624.015 achieved a sensitivity of 59.6% and specificity of 92%. Combining SII with NLR and PLR improved predictive accuracy (area under the curve = 0.787), with sensitivity and specificity of 63.5% and 96%, respectively. Correlation analyses revealed significant associations between SII, metabolic markers (triglycerides, glycated hemoglobin), and UACR. CONCLUSION: SII is a reliable biomarker for early kidney damage in T1DM children, offering high specificity for identifying at-risk patients. Combining SII with NLR and PLR enhances diagnostic precision, supporting its integration into clinical practice. Longitudinal monitoring of these markers may facilitate early interventions to mitigate renal complications in pediatric T1DM.
背景：早期肾损伤是新诊断的1型糖尿病（T1DM）患儿的一种重要并发症。全身炎症在糖尿病肾病的发生发展中起关键作用。包括全身免疫炎症指数（SII）、中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）在内的几种炎症标志物已被提出作为糖尿病并发症的潜在指标。 目的：探讨SII、NLR、PLR与无蛋白尿病史的新诊断T1DM患儿早期肾损伤之间的关联，评估它们作为预测生物标志物的效用。 方法：对2020年1月至2023年6月招募的102例3 - 18岁新诊断T1DM患儿[基线尿白蛋白与肌酐比值（UACR）< 30 mg/g]进行纵向队列研究。参与者每半年随访一次，最长随访三年。在基线和随访时收集人口统计学、临床和实验室数据，包括炎症标志物（SII、NLR、PLR）。采用逻辑回归和受试者工作特征分析来评估这些标志物对定义为UACR≥30 mg/g的早期肾损伤的预测效用。 结果：SII是早期肾损伤的显著独立预测因子[比值比 = 1.002，95%置信区间（CI）：1.0008 - 1.0033，P = 0.0016]，曲线下面积为0.719（95%CI：0.612 - 0.826，P < 0.001）。使用SII阈值≥624.015时，灵敏度为59.6%，特异度为92%。将SII与NLR和PLR联合使用可提高预测准确性（曲线下面积 = 0.787）,灵敏度和特异度分别为63.5%和96%。相关性分析显示SII、代谢标志物（甘油三酯、糖化血红蛋白）和UACR之间存在显著关联。 结论：SII是T1DM患儿早期肾损伤的可靠生物标志物，对识别高危患者具有高特异性。将SII与NLR和PLR联合使用可提高诊断精度，支持将其纳入临床实践。对这些标志物进行纵向监测可能有助于早期干预，以减轻儿童T1DM的肾脏并发症。
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