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Received:March 26, 2025 Published Online:June 28, 2026
Received:March 26, 2025 Published Online:June 28, 2026
中文摘要: 目的 探究血清富亮氨酸α-2糖蛋白-1（LRG1）与分泌型卷曲相关蛋白4（SFRP4）对妊娠期糖尿病（GDM）患者早期肾损伤的诊断价值，为临床GDM肾损伤的预测提供参考依据。方法 选择2022年1月到2023年12月中国人民解放军总医院第七医学中心就诊的118例GDM孕妇及同期产检的正常孕妇112例（对照组）为研究对象。收集所有研究对象的临床资料。根据尿白蛋白/肌酐比值（UACR）将118例GDM孕妇分为无肾损伤GDM组（UACR<30 mg/g，n=72）和肾损伤GDM组（UACR≥30 mg/g，n=46）。采用Pearson相关性分析探讨GDM孕妇血清LRG1、SFRP4水平与血肌酐、白细胞介素-6（IL-6）、血尿素氮、糖化血红蛋白（HbA1C）、估算肾小球滤过率（eGFR）的相关性。采用多因素logistic回归分析发生GDM患者早期肾损伤的影响因素。采用受试者工作特征（ROC）曲线分析血清LRG1、SFRP4水平对GDM患者早期肾损伤的诊断价值。结果 肾损伤GDM组IL-6、血尿素氮、血肌酐、HbA1C、LRG1、SFRP4均高于无肾损伤GDM组（P＜0.05），eGFR低于无肾损伤GDM组（P＜0.05）。肾损伤GDM孕妇血清LRG1、SFRP4分别与血肌酐、IL-6、血尿素氮、HbA1C呈显著正相关（P＜0.05），与eGFR呈显著负相关（P＜0.05）。高IL-6（OR=1.698，95%CI：1.261~2.287）、HbA1C（OR=2.596，95%CI：1.284~5.247）、LRG1（OR=1.563，95%CI：1.214~2.013）、SFRP4（OR=1.893，95%CI：1.185~3.024）是GDM发生肾损伤的独立危险因素（P＜0.05），高eGFR（OR=0.642，95%CI：0.515~0.800）为其独立保护因素（P＜0.05）。LRG1、SFRP4联合检测GDM发生肾损伤的曲线下面积为0.925，优于各自单独检测（Z两者联合-LRG1=2.221，P=0.026；Z两者联合-SFRP4=3.153，P=0.002）。结论 血清LRG1和SFRP4水平对GDM孕妇早期肾损伤有一定的诊断价值。
中文关键词: 富亮氨酸α-2糖蛋白-1 分泌型卷曲相关蛋白4 妊娠期糖尿病 肾损伤 糖化血红蛋白 估算肾小球滤过率
Abstract:Objective To investigate the diagnostic value of serum leucine-rich-alpha-2-glycoprotein-1（LRG1）and secreted frizzled-related protein 4（SFRP4）for early renal injury in patients with gestational diabetes mellitus（GDM）, and to provide a reference for the clinical prediction of GDM-related renal injury. Methods A total of 118 pregnant women with GDM and 112 normal pregnant women undergoing prenatal examination（control group）who visited the Seventh Medical Center of Chinese PLA General Hospital from January 2022 to December 2023 were selected as the study subjects. Clinical data were collected from all subjects. According to urinary albumin-to-creatinine ratio（UACR）, the 118 pregnant women with GDM were divided into GDM without renal injury group（UACR<30 mg/g, n=72）and GDM with renal injury group（UACR≥30 mg/g, n=46）.Pearson correlation analysis was used to explore the correlations of serum LRG1 and SFRP4 levels with serum creatinine, interleukin-6（IL-6）, blood urea nitrogen, glycosylated hemoglobin（HbA1C）, and estimated glomerular filtration rate（eGFR）in pregnant women with GDM. Multivariate logistic regression analysis was performed to analyze the influencing factors of early renal injury in patients with GDM. Receiver operating characteristic（ROC）curve was used to analyze the diagnostic value of serum LRG1 and SFRP4levels for early renal injury in patients with GDM. Results The levels of IL-6, blood urea nitrogen, serum creatinine, HbA1C, LRG1, and SFRP4 in the GDM with renal injury group were significantly higher than those in the GDM without renal injury group, while eGFR was significantly lower（P＜0.05）. Serum LRG1 and SFRP4 in GDM pregnant women with renal injury were significantly positively correlated with serum creatinine, IL-6, blood urea nitrogen, and HbA1C, and significantly negatively correlated with eGFR（P＜0.05）. High IL-6（OR=1.698, 95%CI：1.261-2.287）, HbA1C（OR=2.596, 95%CI：1.284-5.247）, LRG1（OR=1.563, 95%CI：1.214-2.013）, and SFRP4（OR=1.893, 95%CI：1.185-3.024）were independent risk factors for renal injury in GDM, while high eGFR（OR=0.642, 95%CI：0.5150.800）was an independent protective factor（P＜0.05）. The area under the ROC curve of combined detection of LRG1and SFRP4 for renal injury in GDM was 0.925, which was better than that of single detection（Zcombination-LRG1=2.221, P=0.026；Zcombination-SFRP4=3.153, P=0.002）. Conclusion Serum LRG1 and SFRP4 levels have certain diagnostic value for detecting early renal injury in pregnant women with GDM.
keywords: Leucine-rich-alpha-2-glycoprotein-1 Secreted frizzled-related protein 4 Gestational diabetes mellitus Renal injury Glycosylated hemoglobin Estimated glomerular filtration rate
文章编号： 中图分类号：R587.1 文献标志码：A
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