Relationship between urinary DcR2/Cr level and prognosis in patients with diabetic tubulopathy

doi:10.3877/cma.j.issn.2095-3216.2023.02.001

Abstract

Abstract:

Objective

To investigate whether urinary decoy receptor 2/ urine creatinine(DcR2/Cr) could be used as a biomarker to predict the prognosis of diabetic tubulopathy (DT).

Methods

A total of 65 patients who were pathologically diagnosed with DT and had urine specimens retained in our department from 2018 to 2021 were included. Basic data, laboratory findings, and pathological information were collected for retrospective analysis. The patients were followed up, and endpoint events were recorded. Aaccording to urinary DcR2/Cr levels, the patients were divided into three groups, group 1 (DcR2/Cr <321 ng/mmol), group 2 (321≤DcR2/Cr≤505 ng/mmol), and group 3 (DcR2/Cr>505 ng/mmol). Univariate analysis of variance and Kruskal Wallis test were used for groups comparison, and chi square test was used for comparison of rates. Cox regression was applied to analyze the relationship between urinary DcR2/Cr level and prognosis of DT. The data was processed with the SPSS 26.0 statistical software.

Results

With the increase of DcR2/Cr level, urinary albumin-to-creatinine ratio (ACR), N-acetyl-β-D-glucosaminidase (NAG), cystatin C (CYC), and serum creatinine tended to increase, while urinary creatinine and estimated glomerular filtration rate (eGFR) gradually decreased (P<0.05). Hemoglobin and serum albumin levels decreased with the increase of urinary DcR2/Cr level (P<0.05), while triglyceride and low density lipoprotein (LDL) increased with the increase of DcR2/Cr (P<0.05). The DcR2/Cr level was positively correlated with ACR (P<0.01), CYC (P<0.01), and NAG (P<0.01), but negatively correlated with eGFR (P<0.01). The urinary DcR2/Cr level was positively correlated with the interstitial fibrosis and tubular atrophy (IFTA) score, renal artery hyalinosis score, and renal atherosclerosis score (all P<0.05). Cox regression analysis revealed a significant correlation between the urinary DcR2/Cr level and the occurrence of adverse prognosis (P=0.001). The risk of adverse prognosis of the group 3 was 11.416 times that of group 1. The Kaplan-Meier survival curve showed that the higher the urinary DcR2/Cr level, the worse the prognosis in the patients. The receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of urine DcR2/Cr was the largest among ACR, CYC, and SCr.

Conclusion

Urinary DcR2/Cr was closely associated with DT, and may be a biomarker to predict the prognosis of DT.

Key words: Urine, DcR2/Cr, Diabetic tubulopathy, Renal tubular interstitial injury

Weidong Wang, Jia Chen, Yani He, Kehong Chen. Relationship between urinary DcR2/Cr level and prognosis in patients with diabetic tubulopathy[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(02): 61-66.

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Figures/Tables 8

References 23

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临床资料	DcR2/Cr1组(n＝21)	DcR2/Cr2组(n＝22)	DcR2/Cr3组(n＝22)	合计(n＝65)	F/χ²值	P值
年龄(岁)	52.4±8.7	51.7±11.7	53.8±10.4	52.7±10.3	0.406	0.668^b
男性[例(%)]	17(81.0)	18(81.8)	13(59.1)	48(73.8)	3.753	0.153^c
体重指数(kg/m²)	26.0±2.3	24.1±2.4	24.3±2.9^a	24.7±2.7	3.310	0.044^b
收缩压(mmHg)	140.6±21.3	143.1±21.2	144.3±26.2	144.5±23.5	0.047	0.954^b
舒张压(mmHg)	80.1±14.5	78.9±10.6	77.9±12.2	79.6±12.9	0.394	0.676^c
蛋白尿[例(%)]	20(95.2)	21(95.5)	22(100.0)	63(96.9)	1.057	0.589^c
下肢水肿[例(%)]	13(61.9)	17(77.3)	16(72.7)	46(70.8)	1.288	0.525^c
高血压[例(%)]	18(85.7)	20(90.9)	18(81.8)	56(86.2)	0.767	0.681^c
贫血[例(%)]	7(33.3)	14(63.6)^a	15(68.2)^a	36(55.4)	6.197	0.045^c
低白蛋白血症[例(%)]	4(19.0)	11(50.0)	9(40.9)	24(36.9)	4.647	0.098^c
冠心病[例(%)]	2(9.5)	2(9.1)	2(9.1)	6(9.2)	0.003	0.998^c
脑血管疾病[例(%)]	1(4.8)	2(9.1)	3(13.6)	6(9.2)	1.011	0.603^c
慢性肝病[例(%)]	0	3(13.6)	1(4.5)	4(6.2)	3.608	0.165^c
糖尿病视网膜病变[例(%)]	11(57.9)	16(76.2)	16(72.7)	43(69.4)	1.753	0.416^c

临床资料	DcR2/Cr1组(n＝21)	DcR2/Cr2组(n＝22)	DcR2/Cr3组(n＝22)	合计(n＝65)	F/χ²值	P值
年龄(岁)	52.4±8.7	51.7±11.7	53.8±10.4	52.7±10.3	0.406	0.668^b
男性[例(%)]	17(81.0)	18(81.8)	13(59.1)	48(73.8)	3.753	0.153^c
体重指数(kg/m²)	26.0±2.3	24.1±2.4	24.3±2.9^a	24.7±2.7	3.310	0.044^b
收缩压(mmHg)	140.6±21.3	143.1±21.2	144.3±26.2	144.5±23.5	0.047	0.954^b
舒张压(mmHg)	80.1±14.5	78.9±10.6	77.9±12.2	79.6±12.9	0.394	0.676^c
蛋白尿[例(%)]	20(95.2)	21(95.5)	22(100.0)	63(96.9)	1.057	0.589^c
下肢水肿[例(%)]	13(61.9)	17(77.3)	16(72.7)	46(70.8)	1.288	0.525^c
高血压[例(%)]	18(85.7)	20(90.9)	18(81.8)	56(86.2)	0.767	0.681^c
贫血[例(%)]	7(33.3)	14(63.6)^a	15(68.2)^a	36(55.4)	6.197	0.045^c
低白蛋白血症[例(%)]	4(19.0)	11(50.0)	9(40.9)	24(36.9)	4.647	0.098^c
冠心病[例(%)]	2(9.5)	2(9.1)	2(9.1)	6(9.2)	0.003	0.998^c
脑血管疾病[例(%)]	1(4.8)	2(9.1)	3(13.6)	6(9.2)	1.011	0.603^c
慢性肝病[例(%)]	0	3(13.6)	1(4.5)	4(6.2)	3.608	0.165^c
糖尿病视网膜病变[例(%)]	11(57.9)	16(76.2)	16(72.7)	43(69.4)	1.753	0.416^c

实验室检查资料	DcR2/Cr1组(n＝21)	DcR2/Cr2组(n＝22)	DcR2/Cr3组(n＝22)	合计(n＝65)	F/H值	P值
尿蛋白定量(g/L)	1.28(0.5，3.0)	2.5(1.2，4.3)	3.8(1.4，6.1)^a	2.0(0.9，4.8)	5.291	0.071^d
ACR[mg/(g·Cr)]	801(222，2534)	2385(1045，4110)	4743(2242，6237)^a	2352(779.3，4492.5)	14.651	0.001^d
NAG(U/L)	21.2(17.1，36.4)	28.2(18.9，37.7)	55.9(23.5，78.5)^a	28.4(17.9，48.2)	9.581	0.008^d
血红蛋白(g/L)	131.6±23.6	117.4±20.5^a	103.7±25.2^a	114.9±26.0	8.409	0.001^c
血肌酐(μmol/L)	86.1(70.6，112.7)	113.1(84.7，144.5)^a	121.1(84.3，165.9)^a	101.7(81.6，137.8)	7.666	0.022^d
胱抑素C(mg/L)	1.4(1.1，1.6)	1.5(1.3，1.8)	2.0(1.5，2.3)^ab	1.6(1.3，2.0)	13.473	0.001^e
eGFR[ml/(min·1.73 m²)]	77.2±19.2	64.6±26.2^a	57.6±28.5^a	68.2±26.3	6.945	0.002^c
血清白蛋白(g/L)	35.7±7.1	32.7±6.3^a	28.5±8.7^a	32.9±7.7	3.306	0.043^c
总胆固醇(mmol/L)	4.4(3.6，4.9)	4.8(3.8，5.9)	5.5(4.2，7.2)	4.7(4.1，5.9)	4.630	0.099^d
甘油三酯(mmol/L)	1.8(1.0，2.8)	1.6(1.0，2.0)	2.3(1.5，3.2)^b	1.9(1.3，2.7)	7.125	0.028^d
高密度脂蛋白(mmol/L)	1.1±0.2	1.1±0.2	1.2±0.3	1.1±0.3	0.375	0.689^c
低密度脂蛋白(mmol/L)	2.6(2.3，3.2)	3.0(2.3，3.8)	3.4(2.7，4.8)^a	2.9(2.5，3.8)	6.852	0.033^d
空腹血糖(mmol/L)	7.7±3.6	7.0±3.5	7.9±4.1	8.4±4.1	0.438	0.647^c
糖化血红蛋白(%)	7.8(6.6，9.4)	8.1(6.9，9.1)	8.0(6.6，9.5)	7.9(6.6，9.5)	0.171	0.918^d

实验室检查资料	DcR2/Cr1组(n＝21)	DcR2/Cr2组(n＝22)	DcR2/Cr3组(n＝22)	合计(n＝65)	F/H值	P值
尿蛋白定量(g/L)	1.28(0.5，3.0)	2.5(1.2，4.3)	3.8(1.4，6.1)^a	2.0(0.9，4.8)	5.291	0.071^d
ACR[mg/(g·Cr)]	801(222，2534)	2385(1045，4110)	4743(2242，6237)^a	2352(779.3，4492.5)	14.651	0.001^d
NAG(U/L)	21.2(17.1，36.4)	28.2(18.9，37.7)	55.9(23.5，78.5)^a	28.4(17.9，48.2)	9.581	0.008^d
血红蛋白(g/L)	131.6±23.6	117.4±20.5^a	103.7±25.2^a	114.9±26.0	8.409	0.001^c
血肌酐(μmol/L)	86.1(70.6，112.7)	113.1(84.7，144.5)^a	121.1(84.3，165.9)^a	101.7(81.6，137.8)	7.666	0.022^d
胱抑素C(mg/L)	1.4(1.1，1.6)	1.5(1.3，1.8)	2.0(1.5，2.3)^ab	1.6(1.3，2.0)	13.473	0.001^e
eGFR[ml/(min·1.73 m²)]	77.2±19.2	64.6±26.2^a	57.6±28.5^a	68.2±26.3	6.945	0.002^c
血清白蛋白(g/L)	35.7±7.1	32.7±6.3^a	28.5±8.7^a	32.9±7.7	3.306	0.043^c
总胆固醇(mmol/L)	4.4(3.6，4.9)	4.8(3.8，5.9)	5.5(4.2，7.2)	4.7(4.1，5.9)	4.630	0.099^d
甘油三酯(mmol/L)	1.8(1.0，2.8)	1.6(1.0，2.0)	2.3(1.5，3.2)^b	1.9(1.3，2.7)	7.125	0.028^d
高密度脂蛋白(mmol/L)	1.1±0.2	1.1±0.2	1.2±0.3	1.1±0.3	0.375	0.689^c
低密度脂蛋白(mmol/L)	2.6(2.3，3.2)	3.0(2.3，3.8)	3.4(2.7，4.8)^a	2.9(2.5，3.8)	6.852	0.033^d
空腹血糖(mmol/L)	7.7±3.6	7.0±3.5	7.9±4.1	8.4±4.1	0.438	0.647^c
糖化血红蛋白(%)	7.8(6.6，9.4)	8.1(6.9，9.1)	8.0(6.6，9.5)	7.9(6.6，9.5)	0.171	0.918^d

随访情况	DcR2/Cr1组(n＝21)	DcR2/Cr2组(n＝22)	DcR2/Cr3组(n＝22)	合计(n＝65)	H/χ²值	P值
随访时间(月)	11.0(5.5，18.5)	10.5(6.0，24.2)	9.5(6.0，13.5)	10.0(6.0，17.5)	2.237	0.327^d
终点事件[例(%)]	3(1 4.3)	8(36.4)	17(77.3)^ab	28(43.1)	17.995	<0.001^c

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