2型糖尿病肾病患者血清HIF-1α、ChREBP与糖脂代谢、肾功能的关系及其诊断价值分析

摘要 目的：探讨2型糖尿病肾病（T2DKD）患者血清缺氧诱导因子-1α（HIF-1α）、碳水化合物反应元件结合蛋白（ChREBP）与糖脂代谢、肾功能的关系及其诊断价值。方法：选取2021年1月～2022年1月我院收治的100例T2DKD患者为T2DKD组，另选取同期100例单纯T2DM患者T2DM组，选取我院同期100名体检健康者为对照组。检测血清HIF-1α、ChREBP和糖脂代谢指标[空腹血糖（FBG）、餐后2hFBG（2hFBG）、血红蛋白A1c（HbA1c）、稳态模型评估-胰岛素抵抗指数（HOMA-IR）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）]、肾功能指标[尿白蛋白/肌酐比（UACR）、估计肾小球滤过率（eGFR）]。采用Pearson相关性分析T2DKD患者血清HIF-1α、ChREBP水平与糖脂代谢、肾功能指标的相关性，受试者工作特征（ROC）曲线分析血清HIF-1α、ChREBP水平对T2DKD的诊断价值。结果：对照组、T2DM组、T2DKD组血清HIF-1α、ChREBP、FBG、2hFBG、HbA1c、HOMA-IR、TC、TG、LDL-C、UACR水平依次升高，HDL-C、eGFR依次降低（P＜0.05）。Pearson相关性分析显示，T2DKD患者血清HIF-1α、ChREBP水平与FBG、HbA1c、HOMA-IR、TC、TG、LDL-C、UACR呈正相关，与HDL-C、eGFR呈负相关（P＜0.05）。ROC曲线分析显示，血清HIF-1α、ChREBP水平单独和联合诊断T2DKD的曲线下面积分别为0.784、0.787、0.882，HIF-1α、ChREBP水平联合诊断的曲线下面积大于各指标单独预测（P＜0.05）。结论：T2DKD患者血清HIF-1α、ChREBP水平升高与糖脂代谢紊乱和肾功能降低有关，血清HIF-1α、ChREBP水平联合诊断T2DKD具有一定价值。

Relationship between Serum HIF-1α, ChREBP and Glucose and Lipid Metabolism, Renal Function in Patients with Type 2 Diabetic Kidney Disease and its Diagnostic Value

ABSTRACT Objective: To investigate the relationship between serum hypoxia inducible factor-1α(HIF-1α), carbohydrate response element binding protein (ChREBP) and glucose and lipid metabolism, renal function in patients with type 2 diabetic kidney disease (T2DKD) and its diagnostic value. Methods: 100 patients with T2DKD who were admitted to our hospital from January 2021 to January 2022 were selected as T2DKD group, 100 patients with simple T2DM during the same period were selected as T2DM group, and 100 healthy people in our hospital during the same period were selected as control group. Serum HIF-1α, ChREBP and glucose and lipid metabolism indexes [fasting blood glucose (FBG), postprandial 2hFBG (2hFBG), hemoglobin A1c (HbA1c), homeostasis model assessment-insulin resistance index (HOMA-IR), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C)], renal function indexes [urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR)] were detected. The correlation between serum HIF-1α and ChREBP levels and glycolipid metabolism and renal function indexes in T2DKD patients were analyzed by pearson correlation analysis, the diagnostic value of serum HIF-1α and ChREBP levels in T2DKD were analyzed by receiver operating characteristic (ROC) curve. Results: The levels of serum HIF-1α, ChREBP, FBG, 2hFBG, HbA1c, HOMA-IR, TC, TG, LDL-C and UACR in control group, T2DM group and T2DKD group increased in turn, while HDL-C and eGFR decreased in turn(P<0.05). Pearson correlation analysis showed that, serum HIF-1α and ChREBP levels in T2DKD patients were positively correlated with FBG, HbA1 c, HOMA-IR, TC, TG, LDL-C and UACR, and negatively correlated with HDL-C and eGFR(P<0. 05). ROC curve analysis showed that, the area under the curve of serum HIF-1α and ChREBP levels alone and combined diagnosis of T2DKD was 0.784,0.787 and 0.882 respectively, and the area under the curve of combined diagnosis of HIF-1α and ChREBP levels was greater than that of each index alone (P<0.05). Conclusion: The increase of serum HIF-1α and ChREBP levels in T2DKD patients is relate to the disorder of glucose and lipid metabolism and the decrease of renal function, the combination of serum HIF-1α and ChREBP levels has certain value in the diagnosis of T2DKD.