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投稿时间：2025-07-16 网络发布日期：2025-09-19
投稿时间：2025-07-16 网络发布日期：2025-09-19
中文摘要: 目的 比较有无糖尿病肾病（DKD）的 2型糖尿病（T2DM）患者血清腺苷脱氨酶（ ADA）水平，探讨 ADA水平与 DKD发生风险的相关性。方法 研究采用横断面回顾性研究设计，纳入 2019年 1月至 2023年 9月于陆军军医大学第一附属医院住院的 T2DM患者 5 485例，根据是否患有 DKD进行分组（DKD组 1 659例，非DKD组3 826例）。通过病历系统收集两组患者的临床数据及实验室指标并进行比较。采用多因素 logistic回归分析 ADA与 DKD风险的关系并进行亚组分析。结果 5 485例 T2DM患者中， DKD者占 30.24%，ADA水平范围为 0.2~53.9 u/ L。DKD组 ADA水平显著高于非 DKD组［14.0（11.1，22.2）u/L vs 12.0（9.6，15.4）u/L，Z= 20.287，P＜ 0.001］。按 ADA水平四分位分组后， DKD占比呈上升趋势（ Q1组 21.30%，Q2组 25.51%，Q3组 32.56%，Q4组 42.86%）。多因素 logistic回归显示，在校正相关危险因素后，血清 ADA每升高 1 u/L，DKD风险增加 4%（OR=1.040，95%CI：1.011~1.064，P<0.01），Q4组的DKD风险较Q1组升高45%（OR= 1.450，95%CI：1.112~1.893，P=0.007）。亚组分析显示当 β2-微球蛋白 ≥ 3 mg/L时， ADA升高显著增加 DKD风险（ OR= 1.033，95%CI:1.002~1.066，P= 0.039）； eGFR <60mL/（min· 1.73 m2 ）时， ADA效应放大［eGFR30~<60mL/（min· 1.73 m2 ）组， OR= 1.102；eGFR<30mL/（min· 1.73 m2 ）组， OR= 1.150］。结论 T2DM患者中，血清 ADA水平升高与 DKD患病显著相关，尤其在慢性肾脏病 G3期及以后阶段作用显著，其水平动态监测或有助于早期风险分层及个体化干预。
Abstract:Objective To compare the serum adenosine deaminase (ADA) levels in patients with and without diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM), and explore the correlation between ADA levels and the risk of DKD. Methods A cross-sectional retrospective study was conducted, including 5 485 T2DM patients hospitalized at the First Hospital Affiliated to Army Medical University from January 2019 to September 2023. Patients were grouped based on the presence or absence of DKD (1 659 cases in DKD group and 3 826 cases in non-DKD group). Clinical data and laboratory indices of both groups were collected from the medical record system and compared. Multivariate logistic regression analysis was used to examine the relationship between ADA levels and DKD risk, with subgroup analysis performed. Results Among 5 485 T2DM patients, the proportion of DKD was 30.24%, with ADA levels ranging from 0.2 to 53.9 u/L. ADA levels were significantly higher in the DKD group compared to the non-DKD group [14.0 (11.1, 22.2) u/L vs 12.0 (9.6, 15.4) u/L, Z= 20.287, P＜0.01]. After dividing into quartiles based on ADA levels, the proportion of DKD showed an upward trend (Q1 group 21.30%, Q2 group 25.51%, Q3 group 32.56%, Q4 group 42.86%). Multivariate logistic regression showed that, after adjusting for relevant risk factors, each 1 u/L increase in ADA was associated with a 4% increased risk of DKD(OR=1.040, 95%CI: 1.011-1.064, P<0.01),and the Q4 group had a 1.45?fold higher risk of DKD than the Q1 group (OR=1.450, 95%CI:1.112-1.893, P=0.007). Subgroup analysis showed that when β2-microglobulin ≥3mg/L, elevated ADA significantly increased the risk of DKD (OR= 1.033, 95%CI: 1.002-1.066, P= 0.039) ; when eGFR <60 mL/ (min· 1.73 m2 ), the effect of ADA was amplified [ vs eGFR30 to< 60 mL/ (min· 1.73 m2 ) group, OR= 1.102; vs eGFR< 30 mL/ (min· 1.73 m2 ) group, OR= 1.150]. Conclusion Elevated serum ADA levels in T2DM patients are significantly associated with the incidence of DKD, especially in stages G3 and beyond of chronic kidney disease. Dynamic monitoring of ADA levels may aid in early risk stratification and individualized interventions.
keywords: Type 2 diabetes mellitus Diabetic kidney disease Adenosine deaminase Estimated glomerular filtration rate Microglobulin Urine albumin-to-creatinine ratio
文章编号： 中图分类号：R587.2 文献标志码：A
基金项目:重庆市自然科学基金重点项目（CSTB2024NSCQ-KJFZZDX0003）；陆军军医大学第一附属医院院临床项目（2024IITZDB13）
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引用文本：
张芃瑞,彭桂亮,张玉玲,等.2型糖尿病患者血清腺苷脱氨酶水平与糖尿病肾病风险的相关性研究[J].中国临床研究,2025,38(9):1319-1323.
张芃瑞,彭桂亮,张玉玲,等.2型糖尿病患者血清腺苷脱氨酶水平与糖尿病肾病风险的相关性研究[J].中国临床研究,2025,38(9):1319-1323.