尿中性粒细胞明胶酶相关脂质运载蛋白预测老年2型糖尿病患者颈动脉硬化的价值

摘要

Objetive To study the value of urinary neutrophil gelatinase associated lipocalin (NGAL) in predicting carotid atherosclerosis in elderly type 2 DM patients.Methods Two hundred and twenty-five elderly type 2 DM patients were divided into urinary NGAL≤42 ng/mg group (n=100) and urinary NGAL＞42 ng/mg group (n=125).Their clinical data were retrospectively analyzed.Risk factors for carotid atherosclerosis were recorded.The value of risk factors in predicting carotid atherosclerosis was assessed according to the area under the ROC curve.Results The incidence of carotid atheroslerotic plaques was significantly lower in urinary NGAL≤42 ng/mggroup than in urinary NGAL＞42 ng/mg group (32.0％ vs 57.8％,P＜0.05).Age,NGAL,urinary microalbumin/creatinine (ACR),LDL-C,TC,hypertension were positively related with carotid atherosclerosis (P＜0.05) and eGFR was negatively related with carotid atherosclerosis (P＜0.05).Urinary NGAL and ACR were two risk factors for carotid atherosclerosis after adjustment for age,hypertension,hyperlipidemia,and eGFR (P＜0.05).The area under the ROC curve for predicting carotid atherosclerosis was 0.87 and 0.78 respectively.Conclusion Urinary NGAL is an independent risk factor for carotid atherosclerosis in type 2 DM patients.The accuracy of urinary NGAL is higher than that of urinary ACR in predicting carotid atherosclerosis.%目的 探讨肾小管损害标志物尿中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)预测老年糖尿病患者颈动脉粥样硬化的价值.方法 选择2012年3月～2016年6月在新疆自治区人民医院住院的老年2型糖尿病无慢性肾病患者225例,分为低水平组(尿NGAL≤42 ng/mg)100例和高水平组(尿NGAL＞42 ng/mg) 125例,记录与颈动脉硬化发生可能相关的危险因素,回顾性分析2组临床资料.采用ROC曲线下面积判断危险因素预测颈动脉硬化发生的准确性.结果 低水平组与高水平组颈动脉斑块率发生率比较,差异有统计学意义(32.0％ vs 57.8％,P＜0.05).年龄、尿NGAL、尿微量白蛋白/肌酐比值(ACR)、LDL-C、TC和收缩压与颈动脉硬化呈正相关(P＜0.05),估计肾小球滤过率(eGFR)与颈动脉硬化呈负相关.在调整了年龄、收缩压、高脂血症、eGFR等因素后,尿NGAL、尿ACR仍然是2型糖尿病颈动脉硬化的独立影响因素(P＜0.05),预测颈动脉硬化的ROC曲线下面积分别为0.87、0.78.结论 尿NGAL是2型糖尿病患者颈动脉硬化独立危险因素,且其预测颈动脉硬化的准确性高于尿ACR.