Hou Qizhuo, Huang Kangkang, Liang Yunlai, Yu Wenze, Long Lu, Wang Kun, Yi Bin
Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
Sci Rep. 2025 Jul 28;15(1):27438. doi: 10.1038/s41598-025-12941-4.
This study was designed to assess the associations between serum junctional adhesion molecule-like protein (JAML), nesfatin-1, and 25-hydroxy vitamin D (25(OH)D) and the incidence of diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM), as well as to explore their risk assessment value in DKD. Serum JAML, nesfatin-1, and 25(OH)D levels were measured in 227 patients with T2DM. All participants were categorized into tertiles based on their serum JAML, nesfatin-1, and 25(OH)D levels. For statistical analysis, multivariate logistic regression models and restricted cubic splines (RCS) were employed; additionally, receiver operating characteristic (ROC) curves and a nomogram were developed. Of the 227 patients with T2DM, 114 (50.2%) were diagnosed with DKD. The RCS analysis showed an S-shaped association between the serum JAML and DKD incidence and an L-shaped association of serum nesfatin-1 or 25(OH)D with the risk of DKD. Multivariate logistic regression revealed that, after controlling for confounders, individuals in the highest tertile of serum JAML level had a significantly greater risk of developing DKD than those in the lowest tertile (JAML: OR 5.70, 95% CI 2.66-12.22, P < 0.001). Conversely, those in the highest tertile of serum nesfatin-1 and 25(OH)D exhibited significantly reduced risks of DKD progression compared to those in the lowest tertile (nesfatin-1: OR 0.21, 95% CI 0.10-0.44, P < 0.001; 25(OH)D: OR 0.19, 95% CI 0.08-0.45, P < 0.001). The ROC curves showed that the serum JAML levels were better than nesfatin-1 or 25(OH)D at predicting DKD. Finally, a nomogram model based on the above three indicators combined with a history of hypertension, course of diabetes, and history of diabetic complications of retinopathy achieved 87.2% accuracy in assessing risk of DKD in patients with T2DM. Elevated serum JAML levels coupled with reduced nesfatin-1 and 25(OH)D concentrations were significantly associated with increased risk of DKD in patients with T2DM. The nomogram integrating these biomarkers demonstrated quantifiable advantages in risk assessment of DKD.
本研究旨在评估2型糖尿病（T2DM）患者血清连接黏附分子样蛋白（JAML）、nesfatin-1和25-羟基维生素D（25(OH)D）与糖尿病肾病（DKD）发病率之间的关联，并探讨它们在DKD中的风险评估价值。对227例T2DM患者测定血清JAML、nesfatin-1和25(OH)D水平。所有参与者根据其血清JAML、nesfatin-1和25(OH)D水平分为三分位数。统计分析采用多因素逻辑回归模型和限制性立方样条（RCS）；此外，绘制了受试者工作特征（ROC）曲线并构建了列线图。在227例T2DM患者中，114例（50.2%）被诊断为DKD。RCS分析显示血清JAML与DKD发病率呈S形关联，血清nesfatin-1或25(OH)D与DKD风险呈L形关联。多因素逻辑回归显示，在控制混杂因素后，血清JAML水平处于最高三分位数的个体发生DKD的风险显著高于最低三分位数的个体（JAML：OR 5.70，95%CI 2.66-12.22，P < 0.001）。相反，血清nesfatin-1和25(OH)D处于最高三分位数的个体与最低三分位数的个体相比，DKD进展风险显著降低（nesfatin-1：OR 0.21，95%CI 0.10-0.44，P < 0.001；25(OH)D：OR 0.19，95%CI 0.08-0.45，P < 0.001）。ROC曲线显示，血清JAML水平在预测DKD方面优于nesfatin-1或25(OH)D。最后，基于上述三项指标并结合高血压病史、糖尿病病程和视网膜病变糖尿病并发症史构建的列线图模型在评估T2DM患者DKD风险时准确率达到87.2%。血清JAML水平升高以及nesfatin-1和25(OH)D浓度降低与T2DM患者DKD风险增加显著相关。整合这些生物标志物的列线图在DKD风险评估中显示出可量化的优势。
