分析血清结缔组织生长因子(CTGF)、转化生长因子-β1(TGF-β1)、基质金属蛋白酶2(MMP2)水平对糖尿病肾病肾间质纤维化的预测价值。

纳入2017年1月至2019年2月本院收治的172例糖尿病肾病患者设为研究组，同期在我院体检的150例健康体检者设为对照组。检测并对比两组的血清CTGF、TGF-β1、MMP2水平。随访3年，根据肾间质纤维化的发生情况将研究组患者分为发生组和未发生组。采用Logistic回归分析法分析血清CTGF、TGF-β1、MMP2水平与糖尿病肾病肾间质纤维化的关系。采用受试者操作特征(ROC)曲线分析血清CTGF、TGF-β1、MMP2水平对糖尿病肾病肾间质纤维化的预测价值。

研究组肾间质纤维化的发生率为39.53%。与未发生组比较，发生组血清CTGF、TGF-β1水平升高(P<0.05)、血清MMP2水平降低(P<0.05)。年龄≥60岁、高血压、尿微量白蛋白/尿肌酐≥3.12 mg/mmol、糖化血红蛋白≥8.38%、血肌酐≥143.78 μmol/L以及CTGF≥93.99 ng/L、TGF-β1≥80.67 μg/L均是糖尿病肾病肾间质纤维化的危险因素(P<0.05)，血清MMP2水平>99.03 μg/L是其保护因素(P<0.05)。血清CTGF、TGF-β1、MMP2水平联合预测的灵敏度、特异度、曲线下面积(AUC)分别是95.59%、78.85%、0.943，联合预测的灵敏度和AUC均高于单独预测(P<0.05)，特异度与单独预测差异无统计学意义(P>0.05)。

糖尿病肾病患者血清的CTGF、TGF-β1和MMP2水平均为糖尿病肾病肾间质纤维化的影响因素，对肾间质纤维化发生可能具有一定的预测价值，且其联合预测优于单独预测。

To explore the predictive values of serum connective tissue growth factor (CTGF), transforming growth factor-β1 (TGF-β1) and matrix metalloproteinase 2 (MMP2) levels on renal interstitial fibrosis in diabetes nephropathy.

172 patients with diabetes nephropathy admitted to our hospital from January 2017 to February 2019 were included as the research group, and 150 healthy persons who received physical examination in our hospital during the same period were included as the control group. The levels of serum CTGF, TGF-β1, and MMP2 in the two groups were detected and compared. Follow-up lasted for three years, and the patients in the research group were further divided into occurrence group and non-occurrence group according to the situation of renal interstitial fibrosis. The relationships between serum CTGF, TGF-β1 and MMP2 levels and renal interstitial fibrosis in diabetes nephropathy were analyzed with logistic regression method. The receiver operating characteristic (ROC) curve was used to analyze the predictive values of serum CTGF, TGF-β1, and MMP2 levels on renal interstitial fibrosis in diabetes nephropathy.

The incidence of renal interstitial fibrosis was 39.53%. The levels of serum CTGF and TGF-β1 in the occurrence group were higher than those in the non-occurrence group (P< 0.05), and the level of serum MMP2 was lower than that in the non-occurrence group (P< 0.05). Age≥60 years, hypertension, urinary microalbumin / creatinine ratio (ACR) ≥3.12 mg/mmol, glycosylated hemoglobin (HbA1c) ≥8.38%, serum creatinine (Scr) ≥143.78 μmol/L, serum CTGF≥93.99 ng/L, and TGF-β1≥80.67 μg/L, were risk factors for the renal interstitial fibrosis in diabetes nephropathy (P<0.05), while serum MMP2>99.03 μg/L was the protective factor (P<0.05). The sensitivity, specificity, and area under curve (AUC) of combined prediction of serum CTGF, TGF-β1, and MMP2 levels were 95.59%, 78.85%, and 0.943, respectively. The sensitivity and AUC of combined prediction were higher than those of single prediction (P< 0.05), while there was no significant difference between the combined prediction and the single prediction in the specificity (P> 0.05).

The three indexes of CTGF, TGF-β1, and MMP2 were all the influencing factors of renal interstitial fibrosis in diabetes nephropathy, suggesting that they may have a certain predictive value for the occurrence of renal interstitial fibrosis. Their combined prediction value was higher than that of a single index.