Levels of antioxidants and inflammatory factors in female patients with diabetic neurogenic bladder and their clinical significance

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

Abstract

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

CLC Number:

R694.5

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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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.11.004

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

Figures/Tables 7

Fig.1 Propensity distribution of baseline data

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

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

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

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

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

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

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

Fig.2 DNB risk prediction nomogram

Fig.3 Model validation for external data

References 20

[1]	Klee NS, Moreland RS, Kendig DM. Detrusor contractility to parasympathetic mediators is differentially altered in the compensated and decompensated states of diabetic bladder dysfunction[J]. Am J Physiol Renal Physiol, 2019, 317(2): F388-F398.
[2]	Gomez CS, Kanagarajah P, Gousse AE. Bladder dysfunction in patients with diabetes[J]. Curr Urol Rep, 2011, 12 (6): 419-426. doi: 10.1007/s11934-011-0214-0 pmid: 21894526
[3]	Liu Y, Wang X, Wang L, et al. Platelet-to-lymphocyte ratio predicts the presence of diabetic neurogenic bladder[J]. Diabetes Metab Syndr Obes, 2022, 15: 7-13.
[4]	李永智. 糖尿病大鼠膀胱纤维化及氧化应激状态的研究[D]. 济南: 山东大学, 2008.
[5]	Wang CC, Kuo HC. Urothelial dysfunction and chronic inflammation in diabetic patients with overactive bladder[J]. Low Urin Tract Symptoms, 2017, 9(3): 151-156.
[6]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 国际内分泌代谢杂志, 2021, 41(5):482-548.
[7]	Wittig L, Carlson KV, Andrews JM, et al. Diabetic bladder dysfunction:A review[J]. Urology, 2019, 123: 1-6. doi: S0090-4295(18)31095-1 pmid: 30352207
[8]	Blair Y, Wessells H, Pop-Busui R, et al. Urologic complications in diabetes[J]. J Diabetes Complications, 2022, 36(10): 108288.
[9]	Agochukwu-Mmonu N, Pop-Busui R, Wessells H, et al. Autonomic neuropathy and urologic complications in diabetes[J]. Auton Neurosci, 2020, 229: 102736.
[10]	Daneshgari F, Liu G, Birder L, et al. Diabetic bladder dysfunction: Current translational knowledge[J]. J Urol, 2009, 182(6 Suppl): S18-S26.
[11]	Zhang P, Li T, Wu X, et al. Oxidative stress and diabetes: Antioxidative strategies[J]. Front Med, 2020, 14(5):583-600.
[12]	Akash MS, Shen Q, Rehman K, et al. Interleukin-1 receptor antagonist: A new therapy for type 2 diabetes mellitus[J]. J Pharm Sci, 2012, 101(5): 1647-1658.
[13]	Sethi JK, Hotamisligil GS. Metabolic messengers: Tumour necrosis factor[J]. Nat Metab, 2021, 3(10): 1302-1312. doi: 10.1038/s42255-021-00470-z pmid: 34650277
[14]	Giraldez MD, Carneros D, Garbers C, et al. New insights into IL-6 family cytokines in metabolism, hepatology and gastroenterology[J]. Nat Rev Gastroenterol Hepatol, 2021, 18(11): 787-803. doi: 10.1038/s41575-021-00473-x pmid: 34211157
[15]	Akbari M, Hassan-Zadeh V. IL-6 signalling pathways and the development of type 2 diabetes[J]. Inflammopharmacology, 2018, 26(3): 685-698. doi: 10.1007/s10787-018-0458-0 pmid: 29508109
[16]	Hu HC, Lei YH, Zhang WH, et al. Antioxidant and anti-inflammatory properties of resveratrol in diabetic nephropathy: A systematic review and meta-analysis of animal studies[J]. Front Pharmacol, 2022, 13: 841818.
[17]	曹释露, 田文竹, 包喜, 等. 丙二醛、超氧化物歧化酶在糖尿病肾病患者血清中的表达及作用[J]. 宁夏医学杂志, 2022, 44(3):193-196+189.
[18]	范修敬, 陈新豪, 古杰超. 血清谷胱甘肽还原酶与2型糖尿病的关系探究[J]. 中国医学创新, 2021, 18(16):12-15.
[19]	Khairul-Anwar I, Wan-Nazatul-Shima S, Siti-Lailatul-Akmar Z, et al. Evaluation of TNF-α and IL-6 in saliva among diabetic retinopathy patients in East Coast Malaysia[J]. Trop Med Int Health, 2022, 27(3): 310-316.
[20]	Song QX, Sun Y, Deng K, et al. Potential role of oxidative stress in the pathogenesis of diabetic bladder dysfunction[J]. Nat Rev Urol, 2022, 19(10): 581-596.