SFRP1、GDF-15、RBP联合检测在糖尿病肾病早期诊断及预后中的价值OA

Objective:Diabetic kidney disease(DKD)is one of the common microvascular complications of type 2 diabetes mellitus(T2DM)and a major risk factor for end-stage renal disease(ESRD).Currently,urine microalbumin(mAlb)is commonly used for early screening of DKD;however,its sensitivity and prognostic value are limited.Therefore,there is an urgent need to identify more effective novel biomarkers.Secreted frizzled-related protein 1(SFRP1),growth differentiation factor-15(GDF-15),and retinol-binding protein(RBP)have been shown to be involved in the occurrence and development of diabetes and its complications,but their clinical value in DKD remains to be elucidated.This study aims to investigate the value of SFRP1,GDF-15,and RBP in the early diagnosis and prognosis of DKD. Methods:A total of 100 patients with T2DM who visited Zhangjiagang Hospital from July 2023 to June 2024 were selected.According to the urinary albumin-to-creatinine ratio(UACR),patients were divided into a control group(UACR<30 mg/g,n=50)and an observation group(UACR 30-300 mg/g,n=50).Serum GDF-15 levels were measured using a double-antibody sandwich enzyme-linked immunosorbent assay(ELISA),serum SFRP1 levels were measured by ELISA,and urinary RBP levels were measured by immunoturbidimetry.Poor prognosis was defined as a decline in estimated glomerular filtration rate(eGFR)≥15%or initiation of renal replacement therapy during the 2-year follow-up period.According to follow-up outcomes,patients in the observation group were further divided into a good prognosis subgroup and a poor prognosis subgroup.Changes in SFRP1,GDF-15,and RBP levels at baseline and after 2 years were compared between the 2 subgroups.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic performance of SFRP1,GDF-15,and RBP alone and in combination for DKD,as well as the predictive performance of 24 h mAlb alone and in combination with SFRP1,GDF-15,and RBP for poor prognosis in patients with DKD. Results:The serum SFRP1 level in the observation group was significantly lower than that in the control group,whereas the serum GDF-15 level and urinary RBP level were significantly higher than those in the control group(P<0.05).ROC curve analysis showed that serum SFRP1,serum GDF-15,and urinary RBP all had good diagnostic performance for DKD,and their combined detection showed superior performance,with an area under the curve(AUC)of 0.980(95%CI 0.929 to 0.997,P<0.001).At baseline,patients in the good prognosis subgroup had higher serum SFRP1 levels and lower urinary RBP and serum GDF-15 levels than those in the poor prognosis subgroup(all P<0.05).After the 2-year follow-up,patients in the poor prognosis subgroup had lower serum SFRP1 levels and higher serum GDF-15 and urinary RBP levels.Comparisons of these indicators between baseline and 2-year follow-up in both subgroups showed statistically significant differences(P<0.05).The AUC of 24 h mAlb for predicting poor prognosis in patients with DKD over 2 years was 0.729(95%CI 0.585 to 0.845).and when combined with SFRP1,GDF-15,and RBP,the AUC increased to 0.862(95%CI 0.735 to 0.943). Conclusion:Serum SFRP1,serum GDF-15,and urinary RBP may serve as novel diagnostic biomarkers for DKD.Their combination with 24 h mAlb provides higher predictive performance for prognosis in patients with DKD.