血清血管生成素样蛋白4、成纤维细胞生长因子-23水平与糖尿病肾病患者病情严重程度及预后的关系OACSTPCD

Objective To investigate the relationships of serum angiopoietin-like protein 4(ANGPTL4)and fibroblast growth factor-23(FGF-23)levels with the severity and prognosis of patients with diabet-ic nephropathy.Methods A total of 120 patients(diabetic nephropathy group)with diabetic nephrop-athy were selected from July 2018 to July 2020 and divided into mild group(n=62)and severe group(n=58)according to the staging criteria of diabetic nephropathy;based on the prognosis within 3 years,they were also divided into good prognosis group(n=94)and poor prognosis group(n=26).Addition-ally,102 diabetic patients were enrolled as diabetic group,and 81 healthy volunteers were selected as control group.The serum levels of ANGPTL4 and FGF-23 in diabetic nephropathy patients were detected by enzyme-linked immunosorbent assay(ELISA).Logistic regression analysis was used to analyze the influencing factors of prognosis,and receiver operating characteristic(ROC)curves were drawn to ana-lyze the values of ANGPTL4,FGF-23 and their combination in assessing the severity and prognosis of diabetic nephropathy.Results The levels of ANGPTL4 and FGF-23 in the diabetic nephropathy group and simple diabetic group were significantly higher than those in the control group(P＜0.05);compared with the simple diabetic group,the levels of ANGPTL4 and FGF-23 in the diabetic ne-phropathy group were significantly increased(P＜0.05);the levels of ANGPTL4 and FGF-23 in the severe group were significantly higher than those in the mild group(P＜0.05);the ROC curve analysis revealed that the areas under the curve(AUCs)for assessing disease severity of ANGPTL4,FGF-23 and their combination were 0.748,0.781 and 0.858 respectively,and the combined diagnosis was significantly better than FGF-23(Z=2.149,P=0.032)and ANGPTL4(Z=2.886,P=0.004)alone;the levels of ANGPTL4 and FGF-23 in the good prognosis group were significantly lower than those in the poor prognosis group(P＜0.05);significant differences were observed in diabetes dura-tion,blood urea nitrogen(BUN),serum creatinine(Scr),fasting blood glucose(FBG),glycated hemoglobin(HbA1C),hypertension,ANGPTL4 and FGF-23 levels between diabetic nephropathy pa-tients with different prognoses(P＜0.05);the Scr,ANGPTL4 and FGF-23 levels were all risk factors affecting the prognosis of diabetic nephropathy(P＜0.05);the ROC curve analysis for prognosis as-sessment showed that the AUCs of ANGPTL4,FGF-23 and their combination were 0.774,0.795 and 0.874 respectively;the combined diagnosis was significantly better than FGF-23(Z=2.385,P=0.171)and ANGPTL4(Z=2.317,P=0.021)alone.Conclusion The serum levels of ANGPTL4 and FGF-23 are significantly increased in diabetic nephropathy patients,and they have certain refer-ence value for the clinical diagnosis and prognosis assessment of diabetic nephropathy patients.