Abstract:

Objective　To explore the relationship of fibrinogen (FIB) and peripheral blood leukocytes with the degree of renal function impairment in patients with diabetic kidney disease (DKD). Methods　One hundred and sixty-four patients with DKD treated at Shaanxi Hospital of Traditional Chinese Medicine from March 2022 to February 2024 were selected for as the study objects. According to the 24-hour urinary albumin excretion, the patients were divided into a microalbuminuria group [96 patients; 30 mg≤24-hour urinary albumin excretion <300 mg; 50 males and 46 females; (55.79±7.27) years old] and a macroalbuminuria group [68 patients; 24-hour urinary albumin excretion≥300 mg; 36 males and 32 females; (56.50±7.01) years old]. The general data, levels of FIB and fibrinogen degradation products (FDP), FIB to albumin ratios (FAR), lymphocyte counts, monocyte counts, neutrophil counts, eosinophil counts, and basophil counts were compared between the two groups. The multifactorial logistic regression was used to analyze the risk factors affecting renal function impairment in the patients with DKD. t and χ² tests were applied. Results　The levels of blood urea nitrogen (BUN), serum creatinine (Scr), FIB, FDP, and FAR in the macroalbuminuria group were higher than those in the microalbuminuria group [(10.04±3.38) mmol/L vs. (5.83±1.52) mmol/L, (191.59±35.79) mmol/L vs. (81.54±16.10) mmol/L, (3 645.15±725.13) mg/L vs. (2 864.94±759.73) mg/L, (2.05±0.46) mg/L vs. (1.42±0.39) mg/L, and (92.93±33.86) mg/g vs. (73.40±20.40) mg/g], with statistical differences (t=10.772, 26.591, 6.602, 9.455, and 4.598; all P<0.05). The estimated glomerular filtration rate (eGFR) in the macroalbuminuria group was lower than that in the microalbuminuria group [(42.62±12.40) ml/(min·1.732 m²) vs. (82.43±20.43) ml/(min·1.732 m²)], with a statistical difference (t=14.303; P<0.05). The monocyte and neutrophil counts in the macroalbuminuria group were higher than those in the microalbuminuria group [(0.48±0.16) ×10⁹/L vs. (0.35±0.10) ×10⁹/L and (4.21±1.19) ×10⁹/L vs. (3.58±0.88) ×10⁹/L], with statistical differences (t=6.394 and 3.898; both P<0.05). There were no statistical differences in the lymphocyte, eosinophil, and basophil counts between the two groups (all P>0.05). The multifactorial logistic regression analysis revealed that high BUN, Scr, FIB, FDP, FAR, and counts of monocytes and neutrophils, as well as low eGFR were independent risk factors for the severity of renal function impairment in the patients with DKD (all P<0.05). The Pearson correlation analysis indicated that the levels of FIB, FDP, and FAR and monocyte and neutrophil counts were positively correlated with BUN and Scr, and negatively with eGFR (all P<0.05). Conclusions　In patients with DKD, the levels of FIB, FDP, and FAR and counts of monocytes and neutrophils increase, and are positively correlated with the degree of renal function impairment. These indicators are identified as the independent risk factors affecting the degree of renal function impairment in patients with DKD and can serve as indicators for assessing the progression of DKD.

Key words:

Fibrinogen, Peripheral blood leukocytes, Diabetic kidney disease, Degree of renal function impairment

摘要：

目的　探讨纤维蛋白原（fibrinogen，FIB）和外周血白细胞与糖尿病肾病（diabetic kidney disease，DKD）患者肾功能损伤程度的关系。方法　选取2022年3月至2024年2月陕西省中医医院收治的164例DKD患者为研究对象。按24 h尿蛋白定量水平将其分为微量蛋白尿（30 mg≤24 h尿蛋白定量<300 mg）组96例［男50例，女46例，年龄（55.79±7.27）岁］和大量蛋白尿（24 h尿蛋白定量≥300 mg）组68例［男36例，女32例，年龄（56.50±7.01）岁］。比较两组患者一般资料以及FIB、纤维蛋白降解产物（fibrinogen degradation products，FDP）水平和FIB与白蛋白比值（fibrinogen to albumin ratio，FAR）、淋巴细胞计数、单核细胞计数、中性粒细胞计数、嗜酸性粒细胞计数、嗜碱性粒细胞计数。多因素logistic回归分析影响DKD患者肾功能损伤的危险因素。采用t检验、χ²检验。结果　大量蛋白尿组血尿素氮（blood urea nitrogen，BUN）、血肌酐（serum creatinine，Scr）、FIB、FDP、FAR水平高于微量蛋白尿组［（10.04±3.38）mmol/L比（5.83±1.52）mmol/L、（191.59±35.79）mmol/L比（81.54±16.10）mmol/L、（3 645.15±725.13）mg/L比（2 864.94±759.73）mg/L、（2.05±0.46）mg/L比（1.42±0.39）mg/L、（92.93±33.86）mg/g比（73.40±20.40）mg/g］，差异均有统计学意义（t=10.772、26.591、6.602、9.455、4.598，均P<0.05）；大量蛋白尿组估算肾小球滤过率（estimated glomerular filtration rate，eGFR）低于微量蛋白尿组［（42.62±12.40）ml/（min·1.732 m²）比（82.43±20.43）ml/（min·1.732 m²）］，差异有统计学意义（t=14.303，P<0.05）。大量蛋白尿组单核细胞和中性粒细胞计数均高于微量蛋白尿组［（0.48±0.16）×10⁹/L比（0.35±0.10）×10⁹/L、（4.21±1.19）×10⁹/L比（3.58±0.88）×10⁹/L］，差异均有统计学意义（t=6.394、3.898，均P<0.05）。两组淋巴细胞、嗜酸性粒细胞及嗜碱性粒细胞计数差异均无统计学意义（均P>0.05）。多因素logistic回归分析显示，高BUN、Scr、FIB、FDP、FAR和单核细胞、中性粒细胞计数以及低eGFR是影响DKD患者肾功能损伤程度的独立危险因素（均P<0.05）。Pearson相关分析结果显示，FIB、FDP、FAR和单核细胞、中性粒细胞计数水平与BUN、Scr呈正相关（均P<0.05），与eGFR呈负相关（均P<0.05）。结论　在DKD患者中，FIB、FDP、FAR以及单核细胞、中性粒细胞计数均升高，且与其肾功能损伤程度呈正相关。这些指标被识别为影响DKD患者肾功能损伤程度的独立危险因素，可成为评估DKD进展的指标。

关键词:

纤维蛋白原, 外周血白细胞, 糖尿病肾病, 肾功能损伤程度