广西医学

目的探讨血清高迁移率族蛋白B1（HMGB1）联合叉头框转录因子O1（FOXO1）水平对2型糖尿病（T2DM）患者并发糖尿病肾病（DN）的预测效能。方法选取82例T2DM患者作为研究对象，依据T2DM患者是否并发DN分为DN组（n=46）和非DN组（n=36）。比较两组患者的一般资料，采用多因素Logistic逐步回归模型分析T2DM患者并发DN的影响因素；采用受试者工作特征（ROC）曲线分析血清HMGB1联合FOXO1水平对T2DM患者并发DN的预测效能。结果 DN组的空腹血糖水平、HbA1c水平、24 h尿蛋白定量及血清肌酐、尿素氮、HMGB1、FOXO1水平高于非DN组，肾小球滤过率低于非DN组（P<0.05）。多因素Logistic逐步回归分析结果显示，血清HMGB1、FOXO1水平升高是T2DM患者并发DN的危险因素（P<0.05）。Spearman相关性分析结果显示，血清HMGB1、FOXO1水平与T2DM患者并发DN呈正相关（P<0.05）。ROC曲线分析结果显示，血清HMGB1、FOXO1水平单独及联合预测T2DM患者并发DN的灵敏度分别为0.94、0.72、0.98，特异度分别为0.83、0.75、0.92，曲线下面积分别为0.92、0.77、0.98，二者联合预测的效能优于其单独预测效能（P<0.05）。结论血清HMGB1、FOXO1水平升高是T2DM患者并发DN的危险因素，且与T2DM患者并发DN呈正相关，二者联合预测T2DM患者并发DN的效能更佳。

Objective To investigate the predictive performance of serum high mobility group protein B1 (HMGB1) combined with forkhead box O1 (FOXO1) levels for patients with type 2 diabetes mellitus (T2DM) and concomitant diabetic nephropathy (DN). Methods Eighty⁃two patients with T2DM were selected as the research subjects. According to the presence of concomitant DN, T2DM patients were divided into DN group (46 cases) or non⁃DN group (36 cases). General data were compared between the two groups. Multivariate Logistic stepwise regression model was used to analyze the influencing factors for patients with T2DM and concomitant DN. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive performance of serum HMGB1 combined with FOXO1 levels for patients with T2DM and concomitant DN. Results Fasting blood glucose level, HbA1c level, and 24⁃hour urine protein quantification, as well as levels of serum creatinine, urea nitrogen, HMGB1, and FOXO1 in the DN group were higher than those in the non⁃DN group, while the glomerular filtration rate was lower than that in the non⁃DN group (P<0.05). Multivariate Logistic stepwise regression analysis revealed that elevated levels of serum HMGB1 and FOXO1 were influencing factors for patients with T2DM and concomitant DN (P<0.05). Spearman correlation analysis indicated that serum HMGB1 and FOXO1 levels positively correlated with patients with T2DM and concomitant DN (P<0.05). ROC curve analysis depicted that the sensitivities, specificities, and areas under the curve of serum HMGB1 and FOXO1 levels for alone and jointly predicting T2DM patients and concomitant DN were 0.94, 0.72, and 0.98, respectively, 0.83, 0.75, and 0.92, respectively, and 0.92, 0.77, and 0.98, respectively. The combined predictive performance was superior to that of either marker alone (P<0.05). Conclusion Elevated serum HMGB1 and FOXO1 levels are independent risk factors for patients with T2DM and concomitant DN, and positively correlate with its occurrence. The combination of both markers provides superior predictive performance for patients with T2DM and concomitant DN.