| Objective:In this study,the serum levels of Il-18,IL-33 R and TNF-α were measured in patients with type 2 diabetic nephropathy,and the relationship between IL-18,IL-33 R and TNF-α and diabetic nephropathy was analyzed,to provide help for the diagnosis and treatment of diabetic nephropathy.Methods: Ninety type 2 diabetic patients(53 males and 37 females)were selected from the Department of Endocrinology,Yijishan Hospital,Wannan Medical College.The 2021 period was from April 01 to June 01,2022.All subjects met the WHO diagnostic criteria for diabetes(1999)and the expert consensus on the prevention and treatment of diabetic nephropathy(2014).Using SPSS 25.0 software,the general case data(age,sex,etc.)were analyzed.The serum levels of IL-18,IL-33 R and TNF-α in patients with type 2 diabetic nephropathy were analyzed,to compare the difference of them in simple diabetes mellitus(SDM),early diabetic nephropathy(EDKD)and clinical diabetic nephropathy(CDKD),and to compare their predictive efficacy in the diagnosis of diabetic nephropathy,the sensitivity and specificity of serum IL-18,IL-33 R and TNF-α in the diagnosis of diabetic nephropathy were calculated.Results: 1.comparison of data 1.1 comparison of general data among the three groups:Comparison of general data: there were significant differences in age(F: 8.757,P=0.000)and course(F: 6.179,P= 0.003)among SDM,EDKD and CDKD groups(P < 0.05),but no significant difference in sex(P > 0.05).There were significant differences in age between EDKD group and SDM group,CDKD group and EDKD group(P < 0.05).There were significant differences in the course of disease between CDKD group and SDM group,EDKD group and SDM group(P < 0.05).1.2 comparison of clinical and biochemical data among the three groups:There were significant differences in hemoglobin(F: 3.808,P = 0.026),total protein(F: 5.391,P = 0.006)and albumin(F: 14.819,P = 0.000)among the three groups(p < 0.05).There were significant differences in creatinine(F: 11.934,P=0.000),urea nitrogen(F: 7.260,P= 0.001),cystatin-c(F:10.914,P=0.000),Ca(F: 3.372,P= 0.039),UACR(F: 48.953,P=0.000),urinary microalbumin(F: 43.359,P= 0.000),e GFR(F: 12.548,P=0.000),urinary protein(H: 47.018,P=0.000),urinary occult blood(H: 17.986,P= 0.000),24 h UP(H: 30.654,P=0.000)among the three groups(P < 0.05).There was no significant difference in UA,urine creatinine,urine white blood cell and urine glucose.There were significant differences in hemoglobin and albumin between CDKD group and SDM group(P < 0.05).The total protein and albumin of CDKD group were significantly higher than those of EDKD group(P< 0.05).There were significant differences in Cr,BUN,UA,Cys-C,Ca,UACR,urine creatinine,urine microalbumin,e GFR,urine protein,urine occult blood and 24 h UP between CDKD group and SDM group(P<0.05).There were significant differences in Ca,UACR,urine albumin,urine protein,urine occult blood and 24 h UP between CDKD group and EDKD group(P< 0.05).There were significant differences in Cr,BUN,Cys-C,UACR,urinary microalbumin,e GFR and urinary protein between EDKD group and SDM group(P < 0.05).1.3 comparison of Il-18,IL-33 R and TNF-α among three groups: The levels of IL-18,IL-33 R and TNF-α among the three groups were significantly different(P < 0.05)in IL-18(F:5.542,P = 0.005),IL-33R(F: 8.316,P =0.001)and TNF-α(F: 12.634,P =0.000).The levels of IL-33 R and TNF-α in CDKD group were significantly higher than those in SDM group(P <0.05).The levels of IL-18,IL-33 R and TNF-α in EDKD group were significantly higher than those in SDM group(P < 0.05).There was no significant difference between CDKD group and EDKD group.2.correlation analysis The correlation analysis of UACR and each index: UACR and fasting c-peptide,Cr,BUN,UA,Cys-C,urine microalbumin,IL-33 R,TNF-α,urine protein,urine occult blood,24 h up were positively correlated(P < 0.05),UACR was negatively correlated with Hb,total protein,albumin,Ca and e GFR(P< 0.05)3.regression analysis Multivariate logistic regression analysis showed that total protein(OR = 1.242,95% CI = 1.006,1.534)and Il-18(OR = 1.003,95% CI = 1.000,1.006)might be risk factors for diabetic nephropathy in type 2 diabetic patients,albumin(OR = 0.657,95% CI =0.476,0.905)may be a protective factor in type 2 diabetic patients with diabetic nephropathy.4.ROC curve The ROC curves of IL-18,IL-33 R and TNF-α for predicting DKD: the AUC of IL-18,IL-33 R and TNF-α for predicting DKD was 0.730(95% CI 0.617-0.843)(P <0.001),0.691(95% CI 0.581-0.800)(P < 0.005)and 0.773(95% CI 0.675-0.870)(P < 0.001),respectively.The optimal cut-off points were 726.742(sensitivity: 0.870,specificity: 0.611),111.015(sensitivity: 0.315,specificity: 1)and 4.395(sensitivity: 0.778,specificity: 0.694),respectively.Conclusion: 1.The levels of IL-33 R and TNF-α were positively correlated with UACR.2.IL-18 maybe a risk factor for diabetic nephropathy and can predict early diabetic nephropathy. |
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