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目的:探讨内皮损伤指标多配体蛋白聚糖1（SDC1）、不对称二甲基精氨酸（ADMA）对2型糖尿病肾病（DKD）患者早期诊断及病程监测的临床价值。方法:横断面研究。选取2020年12月至2021年12月开滦总manbet官网登录 内分泌科住院的2型糖尿病患者232例进行回顾性分析，根据尿白蛋白/尿肌酐比值（UACR）和估算的肾小球滤过率（eGFR）分为单纯糖尿病组（50例）和DKD组（182例），其中DKD组根据DKD进展风险进一步分为低进展风险糖尿病肾病（LDKD）亚组90例、中进展风险糖尿病肾病（MDKD）亚组55例、高进展风险糖尿病肾病（HDKD）亚组37例。以同期体检中心40名健康者为健康对照组。根据N-乙酰-β-D-氨基葡萄糖苷酶/尿肌酐（NAG/Ucr）水平四分位数值，将DKD组患者分为 Q1~ Q4亚组，分别为45、45、46和46例。检测各组一般生化指标、SDC1和ADMA水平。采用Spearman相关法分析DKD患者SDC1、ADMA与肾小球、肾小管损伤指标相关性。多因素有序Logistic回归分析DKD进展风险及肾小管损伤的影响因素，受试者工作特征（ROC）曲线评价SDC1、ADMA对DKD的诊断性能。 结果:DKD组收缩压、舒张压、甘油三酯（TG）、血肌酐（Scr）、尿酸（UA）、NAG/Ucr、SDC1、ADMA水平高于SDM组和健康对照组（ P均<0.05），总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白B（AporB）、糖化血红蛋白（HbA 1c）水平高于健康对照组，高密度脂蛋白胆固醇（HDL-C）水平低于健康对照组（ P均<0.05）。HDKD亚组SDC1水平高于SDM组和LDKD亚组，ADMA水平高于SDM组，低于LDKD亚组（ P均<0.05）；MDKD亚组SDC1水平高于SDM组和LDKD亚组，ADMA水平高于SDM组，低于LDKD亚组（ P均<0.05）；LDKD亚组SDC1、ADMA水平高于SDM组（ P均<0.05）。NAG/Ucr水平 Q4亚组TC、AporB、HbA 1c、Scr、UACR、SDC1水平高于 Q1亚组，Scr、UACR、SDC1水平高于 Q2亚组， Q3亚组HbA 1c、Scr、UACR、SDC1水平高于 Q1亚组（ P均<0.05）。Spearman相关分析显示，SDC1与UACR、NAG/Ucr呈正相关（ r=0.757、0.566， P均<0.05），与eGFR呈负相关（ r=-0.337， P<0.05）；ADMA与UACR、NAG/Ucr呈正相关（ r=0.197、0.142， P均<0.05）。多因素有序Logistic回归分析显示，SDC1、NAG/Ucr、Scr是DKD进展的独立影响因素（ OR=2.043、1.067、1.047， P均<0.05），SDC1、HbA 1c、UACR是DKD肾小管损伤的独立影响因素（ OR=1.177、1.193、1.002， P均<0.05）。ROC曲线显示，SDC1诊断DKD的曲线下面积（AUC）为0.979，敏感度为92.31%，特异度为92.22%，ADMA诊断DKD的AUC为0.745，敏感度为81.32%，特异度为60.00%，两者联合诊断DKD的AUC为0.981、敏感度为90.66%、特异度为95.66%。 结论:SDC1是DKD进展和肾小管损伤的独立影响因素，可用于诊断早期DKD，并可用于监测DKD进展；ADMA可用于DKD的早期筛查。

Objective:To explore the clinical value of syndecan-1 (SDC1), asymmetric dimethylarginine (ADMA) assessment in the early diagnosis and course monitoring of patients with type 2 diabetic kidney disease (DKD).Methods:This is a cross-sectional study. A total of 232 patients with type 2 diabetes admitted to the Department of Endocrinology of Kailuan General Hospital from December 2020 to December 2021 were included. The general biochemical indexes, SDC1 and ADMA were detected. According to urinary albumin/creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR), patients were divided into simple diabetes group (50 cases) and DKD group (182 cases). According to the risk of progression of DKD, the DKD group was further divided into low-progression diabetic nephropathy (LDKD) subgroup (90 cases), medium-progression diabetic nephropathy(MDKD)subgroup (55 cases), and high-progression diabetic nephropathy(HDKD) subgroup (37 cases). Forty healthy people undergoing physical examination during the same period in our hospital were selected as the healthy control group. According to the quartile value of N-acetyl-β-D-glucosaminase/urinary creatinine (NAG/Ucr), the DKD group was divided into Q1- Q4 subgroups, with 45, 45, 46 and 46 cases, respectively. Spearman correlation was used to analyze the correlation between SDC1, ADMA and glomerular and renal tubule injury indexes in DKD patients. Multifactor ordered Logistic regression was used to analyze the influencing factors of the progression risk of DKD and renal tubular injury. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of SDC1 and ADMA for DKD. Results:The levels of systolic blood pressure, diastolic blood pressure, triglyceride (TG), serum creatinine (Scr), uric acid (UA), NAG/Ucr, SDC1 and ADMA in DKD group were higher than those in SDM group and healthy control group (all P<0.05). The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (ApoB), and hemoglobin A1c (HbA 1c) in DKD group were higher than those in healthy control group, and the level of high density lipoprotein cholesterol (HDL-C) was lower than that in healthy control group (all P<0.05). The SDC1 level in HDKD subgroup was higher than that in SDM group and LDKD subgroup, and the ADMA level was higher than that in SDM group and lower than that in LDKD subgroup (all P<0.05). SDC1 level in MDKD subgroup was higher than that in SDM group and LDKD subgroup, ADMA level was higher than that in SDM group, but lower than that in LDKD subgroup (all P<0.05).The levels of SDC1 and ADMA in LDKD subgroup were higher than those in SDM group (all P<0.05). The levels of TC, AporB, HbA 1c, Scr, UACR and SDC1 in NAG/Ucr Q4 subgroup were higher than those in Q1 subgroup, the levels of Scr, UACR and SDC1 were higher than those in Q2 subgroup, and the levels of HbA 1c, Scr, UACR and SDC1 in Q3 subgroup were higher than those in Q1 subgroup (all P<0.05). Spearman correlation analysis showed that SDC1 was positively correlated with UACR, NAG/Ucr ( r=0.757, 0.566, all P<0.05),and was negatively correlated with eGFR ( r=-0.337, P<0.05). ADMA was positively correlated with UACR, NAG/Ucr ( r=0.197, 0.142, all P<0.05). Multifactor ordered Logistic regression analysis showed that SDC1, NAG/Ucr and Scr were the independent influencing factors of progression risk in DKD patients ( OR=2.043, 1.067, 1.047, 0.660, 1.394, all P<0.05), while SDC1, HbA 1c and ACR were the independent influencing factors of renal tubule injury in DKD patients ( OR=1.177, 1.193, 1.002,all P<0.05). ROC curve showed that the area under the curve (AUC) of SDC1 for DKD diagnosis was 0.979, the sensitivity was 92.31%, and the specificity was 92.22%, while the AUC of ADMA for DKD diagnosis was 0.745, the sensitivity was 81.32%, and the specificity was 60.00%. The AUC, sensitivity and specificity of the combined diagnosis of DKD were 0.981, 90.66% and 95.66%. Conclusions:SDC1 is an independent risk factor of DKD progression and tubular injury in DKD patients, which can be used to diagnose early DKD and monitor the progression of DKD. ADMA is suitable for early screening of DKD.