Objective: Transcutaneous oxygen pressure (TcPO2) is used to assess microcirculation clinically; however, it is not widely available especially in rural hospital. The study was designed to explore potential alternatively biomarkers to assess microcirculation in diabetic kidney disease (DKD).
Methods: A total of 404 patients from Xuzhou first hospital were recruited according to the case records system. Patients were grouped via the ratio of albuminuria and creatinine (ACR; <30 mg/g, 30-300 mg/g, >300 mg/g). Biomarkers in different ACR groups were compared by analysis of variance. Correlation analysis was determined by Pearson or Spearman analysis and binary logistic regression. The receiver operating characteristics (ROC) curve was performed to elucidate the prediction effect of ACR on TcPO2.
Results: A total of 404 diabetic patients were recruited with 248 patients diagnosed as DKD and 156 non-DKDs. Age and cystatin C were significantly higher in the ACR3 group compared with those in the ACR1 group, whereas glomerular filtration rate, low-density lipoprotein cholesterol, and TcPO2 were markedly decreased in the ACR3 group (p < .05). Frequency of low TcPO2 (<40 mm Hg) was markedly increased as increment of ACR stages with 30.2% in the ACR3 group (p < .01). There was a negative correlation between TcPO2 and age, ACR, chronic kidney disease (CKD), fast blood glucose, diabetes mellitus (DM) duration, and diabetic neuropathy. Further, binary logistic regression showed ACR was an independent influence factor for low TcPO2. After adjusting for age, gender, hypertension, DM duration, body mass index, glycated hemoglobin, diabetic neuropathy, and CKD, ACR was still an independent influence factor for TcPO2 (odds ratio = 2.464, p < .01). The area under the ROC curve was 0.768 (95% confidence interval: 0.700-0.836, p < .001) for ACR. The analysis of ROC curves revealed a best cutoff for ACR was 75.25 mg/g and yielded a sensitivity of 71.7% and a specificity of 71.7%.
Conclusions: ACR could be used as an alternative biomarker for assessing microcirculation in DKD patients.
【摘要】 目的 经皮氧分压(TcPO2)被用于临床评估微循环，但在农村医院应用并不广泛，因此本研究旨在探索潜在的替代性生物标志物，以评估糖尿病肾病(DKD)患者的微循环情况。方法 根据病案记录系统，共招募了徐州市第一医院的404例患者。根据尿白蛋白与肌酐比值(ACR)，将患者分为3组(<30 mg/g，30~300 mg/g，>300 mg/g)。采用方差分析比较不同ACR组中的生物标志物。通过Pearson或Spearman相关分析和二元logistic回归进行相关性分析。利用ROC曲线来解释ACR对TcPO2的预测效果。结果 共招募了404例糖尿病患者，其中248例诊断为DKD，156例为非DKD。与ACR1组相比，ACR3组的年龄和胱抑素C显著升高，而GFR、LDL和TcPO2明显降低(P<0.05)。低TcPO2[<40 mmHg(1 mmHg=0.133 kPa)]的发生率随着ACR分组的增加而显著增加，ACR3组为30.2%(P<0.01)。TcPO2与年龄、ACR、CKD、空腹血糖、糖尿病病程和糖尿病神经病变之间存在负相关关系。进一步的二元logistic回归分析显示，ACR是低TcPO2的独立影响因素。在校正了年龄、性别、高血压、糖尿病病程、BMI、HbA1C 、糖尿病神经病变和CKD等因素后，ACR仍然是TcPO2的独立影响因素(OR=2.464，P<0.01)。ACR的ROC曲线下面积为0.768(95% CI 0.700~0.836，P<0.001)。ROC曲线分析显示，ACR的最佳截断点为75.25 mg/g，敏感性为71.7%，特异性为71.7%。结论 ACR可作为评估DKD患者微循环的替代生物标志物。.
Keywords: diabetic kidney disease; microcirculation; ratio of albuminuria and creatinine; transcutaneous oxygen pressure; 尿白蛋白与肌酐比值; 微循环; 糖尿病肾病; 经皮氧分压.
© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.