Abstract:

Objective　To investigate the value of serum Fetuin-A and fatty acid binding protein 4 (FABP4) in the prediction of nephropathy risk in patients with type 2 diabetes mellitus. Methods　A total of 107 patients with type 2 diabetes mellitus admitted to Xi'an Trade Union Hospital from August 2021 to July 2023 were selected, including 55 males and 52 females who were (61.69±9.05) years old; they were divided into a normal albuminuria group (48 cases), a microalbuminuria group (39 cases), and a macroalbuminuria group (20 cases) according to their urinary albuminuria/creatinine ratios. Fifty healthy examinees were selected as a healthy control group, including 26 males and 24 females who were (60.87±8.24) years old. The basic data and levels of FABP4, Fetuin-A, C-reactive protein (CRP), adiponectin, and blood lipids and glucose related indicators were compared. Analysis of variance, LSD-t test, and χ² test were applied. Results　The body mass indexes (BMI) of the normal albuminuria group, the microalbuminuria group, and the macroalbuminuria group were (24.35±3.04) kg/m², (25.06±3.12) kg/m², and (24.88±2.83) kg/m², which were higher than that in the healthy control group [(22.48±2.83) kg/m²] (all P<0.05) . The levels of FABP4, Fetuin-A, and CRP of the normal albuminuria group, the microalbuminuria group, and the macroalbuminuria group were (7.92±1.76) μg/L, (8.46±1.98) μg/L, and (9.23±2.05) μg/L, (330.67±44.32) mg/L, (385.38±49.15) mg/L, and (413.10±56.28) mg/L, and (4.77±1.34) mg/L, (5.83±1.96) mg/L, and (6.59±2.17) mg/L, respectively, which were higher than those in the healthy control group [(6.77±1.32) μg/L, (224.56±31.93) mg/L, and (2.36±1.11) mg/L] (all P<0.05) ; the levels of adiponectin of the normal albuminuria group, the microalbuminuria group, and the macroalbuminuria group were (7.56±2.31) mg/L, (5.21±2.09) mg/L, and (4.33±1.95) mg/L, respectively, which were lower than that in the healthy control group [(11.12±2.43) mg/L] (all P<0.05) . The levels of fasting blood glucose (FBG), glycosylated hemoglobin, type A1C (HbA1c), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triacylglycerol (TG) of the normal albuminuria group, the microalbuminuria group, and the macroalbuminuria group were (8.23±2.79) mmol/L, (8.48±3.18) mmol/L, and (8.51±3.26) mmol/L, (8.79±1.35)%, (8.96±1.47)%, and (9.04±1.52)%, (3.35±0.71) mmol/L, (3.26±0.72) mmol/L, and (3.51±0.77) mmol/L, (5.15±0.97) mmol/L, (5.08±0.95) mmol/L, and (5.18±0.97) mmol/L, and (1.69±0.73) mmol/L, (1.82±0.85) mmol/L, and (1.84±0.79) mmol/L, respectively, which were higher than those in the healthy control group [(4.52±0.67) mmol/L, (5.18±1.03)%, (2.28±0.57) mmol/L, (4.52±0.85) mmol/L, and (1.24±0.42) mmol/L] (P<0.001, P<0.001, P<0.001, P=0.003, and P<0.001) ; the levels of high density lipoprotein cholesterol (HDL-C) of the normal albuminuria group, the microalbuminuria group, and the macroalbuminuria group were (1.12±0.47) mmol/L, (1.15±0.50) mmol/L, and (1.17±0.48) mmol/L, respectively, which were lower than that in the healthy control group [(1.36±0.28) mmol/L] (P=0.030) . There was no statistical difference in 2 h postprandial blood glucose between the normal albuminuria group, the microalbuminuria group, and the macroalbuminuria group (P>0.05). The nephropathy risk in the patients increased with the serum levels of Fetuin-A and FABP4 (both P<0.001). The area under the curve (AUC) of Fetuin-A combined with FABP4 in the prediction of nephropathy in the patients was 0.873 (95%CI 0.782-0.963, P<0.001); the sensitivity was 85.17%; specificity was 84.44%. Conclusion　Serum Fetuin-A combined with FABP4 has high specificity and sensitivity in predicting the nephropathy risk in patients with type 2 diabetes mellitus, and has certain predictive value.

Key words:

Type 2 diabetes mellitus, Serum Fetuin-A, FABP4, Diabetic nephropathy

摘要：

目的　探讨血清血清胎球蛋白A（Fetuin-A）联合脂肪酸结合蛋白4（fatty acid binding protein 4，FABP4）预测2型糖尿病患者糖尿病肾病发病风险的价值。方法　选取2021年8月至2023年7月西安工会医院收治的2型糖尿病患者107例，男55例，女52例，年龄（61.69±9.05）岁。根据尿白蛋白/肌酐比值将患者分为正常白蛋白尿组48例、微量白蛋白尿组39例、大量白蛋白尿组20例。选择50例健康体检者作为健康对照组，男26例，女24例，年龄（60.87±8.24）岁。比较各组基本资料、FABP4、Fetuin-A、C反应蛋白（C-reactive protein，CRP）、脂联素水平和血脂血糖相关指标水平。采用方差分析、LSD-t检验、χ²检验。结果　正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组患者体质量指数（body mass index，BMI）分别为（24.35±3.04）kg/m²、（25.06±3.12）kg/m²、（24.88±2.83）kg/m²，均高于健康对照组的（22.48±2.83）kg/m²（均P<0.05）；正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组患者血清FABP4水平分别为（7.92±1.76）μg/L、（8.46±1.98）μg/L、（9.23±2.05）μg/L，Fetuin-A水平分别为（330.67±44.32）mg/L、（385.38±49.15）mg/L、（413.10±56.28）mg/L，CRP水平分别为（4.77±1.34）mg/L、（5.83±1.96）mg/L、（6.59±2.17）mg/L，均高于健康对照组的（6.77±1.32）μg/L、（224.56±31.93）mg/L、（2.36±1.11）mg/L（均P<0.05），脂联素水平分别为（7.56±2.31）mg/L、（5.21±2.09）mg/L、（4.33±1.95）mg/L，低于健康对照组的（11.12±2.43）mg/L（均P<0.05）；正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组患者空腹血糖（fasting blood glucose，FBG）分别为（8.23±2.79）mmol/L、（8.48±3.18）mmol/L、（8.51±3.26）mmol/L，糖化血红蛋白（glycosylated hemoglobin， type A1C，HbA1c）分别为（8.79±1.35）%、（8.96±1.47）%、（9.04±1.52）%，低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL-C）分别为（3.35±0.71）mmol/L、（3.26±0.72）mmol/L、（3.51±0.77）mmol/L，总胆固醇（total cholesterol，TC）分别为（5.15±0.97）mmol/L、（5.08±0.95）mmol/L、（5.18±0.97）mmol/L，三酰甘油（triacylglycerol，TG）水平分别为（1.69±0.73）mmol/L、（1.82±0.85）mmol/L、（1.84±0.79）mmol/L，均高于健康对照组的（4.52±0.67）mmol/L、（5.18±1.03）%、（2.28±0.57）mmol/L、（4.52±0.85）mmol/L、（1.24±0.42）mmol/L（均P<0.05），高密度脂蛋白胆固醇（high density lipoprotein cholesterol，HDL-C）水平分别为（1.12±0.47）mmol/L、（1.15±0.50）mmol/L、（1.17±0.48）mmol/L，低于健康对照组的（1.36±0.28）mmol/L（P=0.030）；正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组患者餐后2 h血糖差异无统计学意义（P>0.05）；2型糖尿病患者肾病发病风险随着血清Fetuin-A、FABP4水平升高而增加（均P<0.05）；血清Fetuin-A联合FABP4预测2型糖尿病患者肾病发病风险的曲线下面积（AUC）为0.873（95%CI 0.782～0.963，P<0.001），灵敏度85.17%，特异度84.44%。结论　血清Fetuin-A联合FABP4预测2型糖尿病患者肾病发病风险有较高的特异度和灵敏度，具有一定预测价值。

关键词:

2型糖尿病, 血清Fetuin-A, FABP4, 糖尿病肾病