HIF-1α、 VEGF 在预测早期糖尿病肾脏病中的价值

摘要： 目的 通过分析缺氧诱导因子（HIF） -1α和血管内皮生长因子（VEGF）水平与肾小球滤过率（eGFR）的关系， 探讨 HIF-1α、 VEGF 在预测早期糖尿病肾脏病 （DKD） 中的价值。方法 76 例糖尿病肾脏病患者根据 eGFR 水平分为 DKD1 组 ［eGFR＞90 mL （min·1.73 m2）， 48 例］ 和 DKD2 组 ［60 mL/ （min·1.73 m2） ＜eGFR≤90 mL/ （min·1.73 m2）， 28 例］， 另择同期健康体检者 23 例为对照组。采用液相免疫沉淀透射比浊法检测 24 h 尿微量白蛋白， 计算尿白蛋白排泄率（UAE）； 酶联免疫吸附试验（ELISA）检测 HIF-1α、 VEGF。结果 DKD1 组、 DKD2 组 UAE、 HIF-1α、 VEGF 水平均明显高于对照组（均 P＜0.05）； DKD2 组 UAE 水平与 DKD1 组差异无统计学意义， HIF-1α、 VEGF 水平高于 DKD1 组 （均 P＜0.05）。HIF-1α、 VEGF 与 eGFR 均呈负相关 （r 分别为-0.551、 -0.593， P < 0.05）。ROC 曲线显示， 血清 HIF-1α和 VEGF 的 ROC 曲线均位于机会对角线以上； HIF-1α对 DKD1 和 DKD2 诊断的敏感度分别为 92.1%、 87.4%， 特异度分别为 91.7%、 85.4%； VEGF 的敏感性分别为 96.1%、 86.2%， 特异度分别为 93.3%、 89.1%。结论 血清 HIF-1α和 VEGF 水平随糖尿病肾脏病进展的严重程度而发生变化， 有可能作为糖尿病肾脏病的早期预测指标。

The predictive values of HIF-1 and VEGF in early diabetic nephropathy

Abstract：Objective To investigate the predictive values of hypoxia- induced factor(HIF)- 1α and vascular endothelial growth factor (VEGF) in patients with type 2 diabetic kidney disease, and its relationship between HIF- 1α, VEGF and glomerular filtration rate (eGFR). Methods Seventy- six patients with type 2 diabetic kidney disease were divided into two groups: DKD1 group eGFR＞90 mL/(min·1.73 m2)， n=48] and DKD2 group 60 mL/(min·1.73 m2)＜eGFR≤ 90 mL/(min·1.73 m2), n=28], according to eGFR results. Twenty-three cases with healthy physical examination were used as the control group. The liquid phase immunoprecipitation and transmission turbidity methods were used to detect 24-h urine albumin, and urinary albumin excretion rate (UAE) was calculated. The serum VEGF and HIF-1α levels were measured by ELISA. Results Serum levels of UAE, HIF-1α and VEGF were significantly higher in DKD1 and DKD2 groups than those in control group (P < 0.05). There was no significant difference in UAE levels between DKD1 and DKD2 groups (P＞0.05). Serum levels of HIF-1α and VEGF were significantly higher in DKD2 group than those of DKD1 group (P＜0.05). There were negative correlation between VEGF and HIF-1α levels with eGFR level (r=-0.59, P < 0.01; r=-0.55, P < 0.01). ROC curve showed that serum VEGF and HIF-1α levels were above the opportunity diagonal. The diagnostic sensitivities of HIF- 1 to DKD1 and DKD2 were 92.1% and 87.4%. The diagnostic specificities of HIF-1 to DKD1 and DKD2 were 91.7% and 85.4%. The diagnostic sensitivities of VEGF to DKD1 and DKD2 were 96.1% and 86.2%, and specificities were 93.3% and 89.1%. Conclusion Serum levels of VEGF and HIF-1α change with the severity of diabetic nephropathy are likely to be an early predictor for the progression of diabetic kidney disease.