女性糖尿病神经源性膀胱患者抗氧化和炎症因子水平及其临床意义

doi:10.3969/j.issn.1004-583X.2024.11.004

摘要/Abstract

摘要：

目的观察糖尿病神经源性膀胱(DNB)患者的抗氧化和炎症因子水平,并分析其临床意义。方法回顾2020年1月至2021年12月在南通大学附属常熟内分泌科就诊的321例女性糖尿病(DM)患者,分成DNB组及DM组。通过倾向性评分后按1∶3匹配,分析匹配后两组血浆抗氧化和炎症因子水平。将P<0.1的因素作为因变量建立logistic回归方程,并构建列线图进行DNB风险预测;同时将倾向性评分未匹配样本的肿瘤坏死因子(TNF-α)、白介素-6(IL-6)、超氧化物歧化酶(SOD)及谷胱甘肽还原酶(GR)数据进行外部验证。结果两组匹配前在病程、体重指数、合并高血压、糖化血红蛋白、肌酐、总胆固醇方面差异均有统计学意义,对基线数据进行倾向性评分匹配后基线数据差异无统计学意义。匹配后DNB组TNF-α[(47.75±13.04) ng/L]与匹配后DM组[(43.18±10.25) ng/L]差异有统计学意义(P<0.05),两组IL-6[(15.45±5.78) vs (13.91±4.62) ng/L]差异无统计学意义。两组SOD[(56.33±6.53) vs (58.75±7.63) ng/ml]及GR[(73.93±17.53) vs (82.18±23.65) ng/L]差异均有统计学意义(P<0.05)。多因素logistic回归分析显示TNF-α、IL-6及GR是DM患者发生DNB的独立危险因素(P<0.05)。回归方程的拟合度 $R 2$ =0.158, $F$ =4,P=0.0006。纳入未匹配样本的数据进行外部验证显示受试者工作特征=0.795,P<0.01。结论 DNB患者的血浆抗氧化因子水平下降,炎症因子水平显著上升,其中TNF-α、IL-6及GR是DNB的危险因素,抗氧化及炎症因子建立的预测模型能够在一定程度上区分出DNB。

关键词: 膀胱, 神经原性, 糖尿病并发症, 抗氧化因子, 炎症因子, 预测模型

Abstract:

Objective To observe the levels of antioxidant and inflammatory factors in female patients with diabetic neurogenic bladder (DNB) and to analyze their clinical significance. Methods A total of 321 female patients with diabetes mellitus (DM) visited the Endocrinology Department of Affiliated Changshu Hospital of Nantong University from January 2020 to December 2021 were included. They were divided into DNB group and DM group, matched by 1∶3 after passing the tendency score. Plasma levels of antioxidant and inflammatory factors in the matched two groups were analyzed by t-test, and tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), superoxide dismutase (SOD) and glutathione reductase (GR) with P<0.1 were established as logistic regression equations for the dependent variable, and a nomogram was constructed for DNB risk prediction. Plasma levels of TNF-α, IL-6, SOD and GR with unmatched propensity scores were externally verified. Results There were significant differences in disease course, body mass index, hypertension, glycated hemoglobin, creatinine, and total cholesterol between the two groups before matching, and there was no significant differences in baseline data after the preference score after matching the baseline data. There were significant differences in plasma levels of TNF-α in the matched DNB group (47.75±13.04) ng/L and TNF-α (43.18±10.25) ng/L in the matched DM group (P<0.05), while no significant difference was detected in IL-6 level (15.45± 5.78 ng/L vs 13.91±4.62 ng/L, P>0.05). There were significant differences in SOD (56.33±6.53 ng/ml vs 58.75±7.63 ng/ml) and GR (73.93±17.53 ng/L vs 82.18±23.65 ng/L)(P<0.05). Multivariate logistic regression analysis showed that TNF-α, IL-6 and GR were independent risk factors for DNB occurrence (P<0.05). The fit of the regression equation obtained the following statistical data: $R 2$ =0.158, $F$ =4, P=0.0006. External validation of data rows including unmatched samples showed that the area under the curve (AUC) was 0.795(P<0.01). Conclusion In female patients with DNB, plasma antioxidant factors decrease, while inflammatory factors significantly increase. Among them, TNF-α, IL-6, and GR are identified as risk factors for DNB. Additionally, the prediction model established based on these antioxidant and inflammatory factors is able to differentiate DNB to some extent.

Key words: urinary bladder, neurogenic, diabetes complications, antioxidant factors, inflammatory factors, predictive models

中图分类号:

R694.5

王欢, 沈婷, 孔颖宏, 居悦俊. 女性糖尿病神经源性膀胱患者抗氧化和炎症因子水平及其临床意义[J]. 临床荟萃, 2024, 39(11): 984-988.

Wang Huan, Shen Ting, Kong Yinghong, Ju Yuejun. Levels of antioxidants and inflammatory factors in female patients with diabetic neurogenic bladder and their clinical significance[J]. Clinical Focus, 2024, 39(11): 984-988.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.11.004

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I11/984

图/表 7

图1 基线数据倾向性分布情况

Fig.1 Propensity distribution of baseline data

表1 两组一般资料比较

Tab.1 General data between the two groups

变量	匹配前				匹配后
变量	DNB组	DM组	$t$ /χ²值	P值	DNB组	DM组	$t$ /χ²值	P值
例数	71	250	-	-	56	115	-	-
年龄(岁)	57.48±11.81	57.13±13.61	0.196	0.844	57.86±11.72	56.81±13.68	0.493	0.622
病程(年)	11.52±5.99	15.00±5.60	4.550	<0.001	12.30±5.94	13.88±5.57	1.703	0.095
BMI(kg/m²)	26.00±5.30	24.37±5.13	2.345	0.019	25.75±5.53	25.85±4.96	0.119	0.905
合并高血压[例(%)]	30( 42.3)	162(64.8)	11.690	<0.001	29(51.8)	61(53.0)	0.023	0.877
胰岛素治疗[例(%)]	57(80.3)	173(69.2)	3.343	0.067	42(75.0)	89(77.4)	0.120	0.729
空腹血糖(mmol/L)	8.55±1.69	8.20±2.06	1.311	0.191	8.44±1.68	8.51±2.08	0.219	0.826
HbA₁c(%)	8.28±1.20	7.79±1.09	3.268	0.001	8.24±1.14	8.12±1.04	0.686	0.494
ALT(U/L)	48.17±5.40	48.40±6.42	0.275	0.783	47.84±4.05	48.01±6.83	0.172	0.863
AST(U/L)	51.31±4.50	51.46±5.61	0.207	0.836	51.32±5.68	51.14±5.60	0.196	0.844
CR(μmol/L)	101.59±10.99	96.56±11.45	3.295	0.001	100.46±10.92	99.57±10.31	0.519	0.604
BUN(mmol/L)	6.19±1.28	6.40±1.17	1.307	0.192	6.30±1.26	6.36±1.28	0.289	0.772
TG(mmol/L)	2.10±0.41	2.09±0.34	0.209	0.835	2.11±0.40	2.07±0.37	0.645	0.519
TC(mmol/L)	6.10±0.76	5.82±0.98	2.240	0.027	6.09±0.82	5.92±1.06	1.056	0.297
DR[例(%)]	22(31.0)	84(31.2)	0.171	0.679	20(35.7)	44(38.3)	0.104	0.747
DPN[例(%)]	36(50.7)	171(68.4)	7.561	0.006	31(55.4)	60(52.1)	0.153	0.695
DN[例(%)]	19(26.8)	83(33.2)	1.058	0.303	18(35.3)	41(35.6)	0.205	0.651

表1 两组一般资料比较

Tab.1 General data between the two groups

变量	匹配前				匹配后
变量	DNB组	DM组	$t$ /χ²值	P值	DNB组	DM组	$t$ /χ²值	P值
例数	71	250	-	-	56	115	-	-
年龄(岁)	57.48±11.81	57.13±13.61	0.196	0.844	57.86±11.72	56.81±13.68	0.493	0.622
病程(年)	11.52±5.99	15.00±5.60	4.550	<0.001	12.30±5.94	13.88±5.57	1.703	0.095
BMI(kg/m²)	26.00±5.30	24.37±5.13	2.345	0.019	25.75±5.53	25.85±4.96	0.119	0.905
合并高血压[例(%)]	30( 42.3)	162(64.8)	11.690	<0.001	29(51.8)	61(53.0)	0.023	0.877
胰岛素治疗[例(%)]	57(80.3)	173(69.2)	3.343	0.067	42(75.0)	89(77.4)	0.120	0.729
空腹血糖(mmol/L)	8.55±1.69	8.20±2.06	1.311	0.191	8.44±1.68	8.51±2.08	0.219	0.826
HbA₁c(%)	8.28±1.20	7.79±1.09	3.268	0.001	8.24±1.14	8.12±1.04	0.686	0.494
ALT(U/L)	48.17±5.40	48.40±6.42	0.275	0.783	47.84±4.05	48.01±6.83	0.172	0.863
AST(U/L)	51.31±4.50	51.46±5.61	0.207	0.836	51.32±5.68	51.14±5.60	0.196	0.844
CR(μmol/L)	101.59±10.99	96.56±11.45	3.295	0.001	100.46±10.92	99.57±10.31	0.519	0.604
BUN(mmol/L)	6.19±1.28	6.40±1.17	1.307	0.192	6.30±1.26	6.36±1.28	0.289	0.772
TG(mmol/L)	2.10±0.41	2.09±0.34	0.209	0.835	2.11±0.40	2.07±0.37	0.645	0.519
TC(mmol/L)	6.10±0.76	5.82±0.98	2.240	0.027	6.09±0.82	5.92±1.06	1.056	0.297
DR[例(%)]	22(31.0)	84(31.2)	0.171	0.679	20(35.7)	44(38.3)	0.104	0.747
DPN[例(%)]	36(50.7)	171(68.4)	7.561	0.006	31(55.4)	60(52.1)	0.153	0.695
DN[例(%)]	19(26.8)	83(33.2)	1.058	0.303	18(35.3)	41(35.6)	0.205	0.651

表2 两组炎症因子比较

Tab.2 Inflammatory factors between the two groups

组别	例数	TNF-α(ng/L)	IL-6(ng/L)
DNB	56	47.75±13.04	15.45±5.78
DM	115	43.18±10.25	13.91±4.62
$t$ 值		2.496	1.880
P值		0.014	0.061

表2 两组炎症因子比较

Tab.2 Inflammatory factors between the two groups

组别	例数	TNF-α(ng/L)	IL-6(ng/L)
DNB	56	47.75±13.04	15.45±5.78
DM	115	43.18±10.25	13.91±4.62
$t$ 值		2.496	1.880
P值		0.014	0.061

表3 两组抗氧化因子比较

Tab.3 Antioxidant factors between the two groups

组别	例数	SOD(ng/ml)	GR(ng/L)
DNB	56	56.33±6.53	73.93±17.53
DM	115	58.75±7.63	82.18±23.65
$t$ 值		2.013	2.317
P值		0.045	0.021

表3 两组抗氧化因子比较

Tab.3 Antioxidant factors between the two groups

组别	例数	SOD(ng/ml)	GR(ng/L)
DNB	56	56.33±6.53	73.93±17.53
DM	115	58.75±7.63	82.18±23.65
$t$ 值		2.013	2.317
P值		0.045	0.021

表4 DNB的多因素logistic回归分析

Tab.4 Multivariate logistic regression analysis of DNB

自变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
自变量	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
常数项	0.519	1.746	0.297		1.680
TNF-α	0.044	0.018	2.471	0.007	1.046	1.003	1.089
IL-6	0.070	0.034	2.083	0.036	1.073	1.004	1.142
SOD	-0.039	0.020	-1.915	0.055	0.961	0.938	0.984
GR	-0.018	0.008	-2.389	0.015	0.982	0.976	1.008

图2 DNB风险预测列线图

Fig.2 DNB risk prediction nomogram

图3 外部数据的模型验证

Fig.3 Model validation for external data

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