【摘要】 目的 分析尿Dickkopf相关蛋白3(DKK3)、人基质金属蛋白酶抑制因子-2(TIMP-2)联合检测对职业性铅中毒患者肾损伤的预测价值，为早期识别及诊断职业性铅中毒提供实用工具。方法 研究对象为2022年1月—2024年1月山东第一医科大学附属职业病医院收治的职业性铅中毒患者，共128例。统计职业性铅中毒患者肾损伤发生情况。将患者分为发生组（n=45）与未发生组（n=83）。比较两组患者的一般信息、基础生命体征指标、实验室数据。采用单因素分析筛选出职业性铅中毒肾损伤影响因素，多因素Logistic回归分析筛选出职业性铅中毒肾损伤的独立危险因素。通过构建预测模型，绘制受试者操作特征（ROC）曲线，分析DKK3与TIMP-2联合预测模型的诊断效能以及与单独DKK3与TIMP-2检测间的差异性。结果 单因素分析结果中，职业性铅中毒患者发生组的DKK3表达量、TIMP-2水平均高于未发生组（t=8.063、8.164，均P<0.05）；多因素回归分析结果显示，DKK3(OR:1.009,95%CI:1.005～1.013)、TIMP-2(OR:7.377,95%CI:3.041～17.895)均为职业性铅中毒患者肾损伤的独立危险因素（均P<0.05）；尿DKK3与TIMP-2联合预测模型的曲线下面积（AUC）为0.925，灵敏度和特异度分别为88.89%、89.16%，均高于DKK3单独检测的灵敏度（71.11%）、特异度（89.16%）与TIMP-2单独检测的灵敏度（80.00%）和特异度（79.52%）。DKK3与TIMP-2联合模型的预测效能较好。结论 尿DKK3与TIMP-2联合模型预测检测职业性铅中毒患者肾损伤的效能较高，为该疾病的早期临床筛选与评估提供了重要参考指标。更多还原

【Abstract】 Objective To explore the predictive value of urinary Dickkopf wnt signaling pathway inhibitor 3(DKK3) and human tissue inhibitor of matrix metalloproteinase-2(TIMP-2) in the detection of renal injury in occupational lead poisoning patients, and to provide a practical tool for early identification and diagnosis.Methods A total of 128 cases of occupational lead poisoning patients admitted to Shandong First Medical University affiliated occupational disease Hospital from January 2022 to January 2024 were studied. The incidence of renal injury in occupational lead poisoning patients was analyzed. Patients were divided into occurrence group(n=45) and non-occurrence group(n=83). The general information, basic vital signs and laboratory data of the two groups were compared. Single factor analysis was used to screen out the influential factors of occupational lead poisoning kidney injury, and multiple Logistic regression analysis was used to screen out the independent risk factors of occupational lead poisoning kidney injury. By constructing prediction model and drawing receiver operating characteristic(ROC) curve, the diagnostic efficiency of DKK3 and TIMP-2 combined prediction model and the difference between DKK3 and TIMP-2 detection were analyzed.Results In the results of univariate analysis, the expression of DKK3 and TIMP-2 in the occupational lead poisoning group were higher than those in the non-occupational lead poisoning group(t=8.063, 8.164, both P<0.05); the results of multiple regression analysis show that, DKK3(OR: 1.009, 95%CI: 1.005-1.013) and TIMP-2(OR: 7.377, 95%CI: 3.041-17.895)were independent risk factors of renal injury in occupational lead poisoning patients(both P<0.05);the area under the curve(AUC) of the combined prediction model of urine DKK3 and TIMP-2 was 0.925, and the sensitivity and specificity were 88.89% and 89.16%, respectively, which were higher than the sensitivity(71.11%) and specificity(89.16%) of DKK3 alone detection and the sensitivity(80.00%) and specificity(79.52%) of TIMP-2 alone detection. It is suggested that the combined prediction model of DKK3 and TIMP-2 has good performance.Conclusion The cbined urinary DKK3 and TIMP-2 model has high efficacy in predicting and detecting renal injury in patients with occupational lead poisoning, which provides an important reference index for early clinical screening and evaluation of this disease.更多还原