Diagnosis value of serum lipoprotein α, cystatin-C and uric acid on early diabetic nephropathy

doi:10.3969/j.issn.1004-583X.2022.03.009

Abstract

Abstract:

Objective To analyze the diagnostic value of serum lipoprotein (α)[LP(α)], cystatin-C (Cys-C) and uric acid (UA) on early diabetic nephropathy (DN). Methods In this retrospective analysis, 150 diagnosed type 2 diabetes mellitus (T2DM) patients admitted to Huludao Central Hospital from January 2020 to August 2021 were enrolled, according to urinary albumin/creatinine ratio (UACR), those patients were assigned into normal albuminuria (NA) group (n=50, UACR: 0~3 mg/mmol), microalbuminuria (MA) group (n=51, UACR: 3~29 mg/mmol), clinical albuminuria (CA) group (n=49, UACR>30 mg/mmol). The general clinical data, correlated clinical indexes, Serum LP(α), Cys-C, UA level were detected and compared among three groups. Pearson's correlation and Logistic regression analysis were used to analyze the correlation between each index and DN; receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of each index for DN.Results Among three groups, difference was statistically significant in the systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P<0.05); there were significant differences in the serum creatine (SCr), estimated glomerular filtration rate (eGFR), fasting plasma glucose (FPG), glycosylated hemoglobin A₁c (HbA₁c), Cys-C, UA, LP(α) (P<0.05). LP(α) in MA group significantly increased when compared with NA group, with statistically significant difference (P<0.05). Pearson's correlation showed that serum Cys-C, UA, LP(α) were positively correlated with UACR and SCr, while negatively correlated with eGFR. Logistic regression analysis showed that the independent risk factors for early DN included Cys-C and LP(α). The results of ROC curve analysis showed that serum Cys-C and LP(α) had high diagnostic value for early DN. Conclusion Different degrees of renal damage in T2DM patients were reflected by Serum LP(α), Cys-C and UA, of which LP(α) and Cys-C being independent risk factors for early DN. The highest accuracy emerges in the combined of the three, with high diagnostic efficacy of prediction for early DN.

Key words: diabetic nephropathies, lipoprotein α, cystatin-C, uric acid, type 2 diabetes mellitus, urinary albumin/creatinine ratio

CLC Number:

R587.24

Gao Shixin, Song Bing, Shi Kexin. Diagnosis value of serum lipoprotein α, cystatin-C and uric acid on early diabetic nephropathy[J]. Clinical Focus, 2022, 37(3): 248-252.

Add to citation manager EndNote|Ris|BibTeX

URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.03.009

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I3/248

Figures/Tables 6

References 17

[1]	毛维维. 血清胱抑素C水平对糖尿病视网膜病变合并糖尿病肾病的诊断价值[J]. 医学临床研究, 2021, 38(4):619-621.
[2]	Zheng Y, Ley SH, Hu FB . Global aetiology and epidemiology of type 2 diabetes mellitus and its complications[J]. Nat Rev Endocrinol, 2018, 14(2):88-98. doi: 10.1038/nrendo.2017.151 pmid: 29219149
[3]	Sagoo MK, Gnudi L. Diabetic nephropathy: An overview[J]. Methods Mol Biol, 2020, 2067:3-7.
[4]	周蓓蓓, 杨帆. 糖尿病肾病损伤标志物的研究进展[J]. 华夏医学, 2019, 32(1):162-165.
[5]	Fineberg D, Jandeleit-Dahm KA, Cooper ME. Diabetic nephropathy: Diagnosis and treatment[J]. Nat Rev Endocrinol, 2013, 9(12):713-723. doi: 10.1038/nrendo.2013.184 pmid: 24100266
[6]	崔娇娇, 雷根平, 董盛. 早期诊断糖尿病肾病生化指标的研究进展[J], 中华实用诊断与治疗杂志, 2021, 35(5)538-540.
[7]	Li Y, Teng D, Shi X, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: National cross sectional study[J]. BMJ, 2020, 369:m997.
[8]	Zhang XX, Kong J, Yun K. Prevalence of diabetic nephropathy among patients with type 2 diabetes mellitus in China: A meta-analysis of observational studies[J]. J Diabetes Res, 2020: 2315607.
[9]	Ghys L, Paepe D, Smets P, et al. Cystatin C: A new renal marker and its potential use in small animal medicine[J]. J Vet Intern Med, 2014, 28(4):1152-1164. doi: 10.1111/jvim.12366 pmid: 24814357
[10]	Ren X, Zhang Z, Yan Z. Association Between Lipoprotein(A) and diabetic nephropathy in patients with type 2 diabetes mellitus: A meta-analysis[J]. Front Endocrinol (Lausanne), 2021, 12:633529. doi: 10.3389/fendo.2021.633529 URL
[11]	Xuan L, Wang T, Dai H, et al. Serum lipoprotein (a) associates with a higher risk of reduced renal function: A prospective investigation[J]. J Lipid Res, 2020, 61(10):1320-1327. doi: 10.1194/jlr.RA120000771 URL
[12]	Lin J, Reilly MP, Terembula K, et al. Plasma lipoprotein(a) levels are associated with mild renal impairment in type 2 diabetics independent of albuminuria[J]. PLoS One, 2014, 9(12):e114397. doi: 10.1371/journal.pone.0114397 URL
[13]	Kim J, Lee CM, Kim HJ. Biomarkers for chronic kidney disease in dogs: a comparison study[J]. J Vet Med Sci, 2020, 82(8):1130-1137. doi: 10.1292/jvms.20-0125 URL
[14]	Hu Y, Zhao H, Lu J, et al. High uric acid promotes dysfunction in pancreatic β cells by blocking IRS2/AKT signaling[J]. Mol Cell Endocrinol, 2020, 520:111070. doi: 10.1016/j.mce.2020.111070 URL
[15]	白慧华, 周铸, 邓楠. 2型糖尿病患者发生血管并发症的危险因素分析[J]. 海南医学, 2018, 29(13):1802-1804.
[16]	Lanaspa MA, Ishimoto T, Cicerchi C, et al. Endogenous fructose production and fructokinase activation mediate renal injury in diabetic nephropathy[J]. J Am Soc Nephrol, 2014, 25(11):2526-2538. doi: 10.1681/ASN.2013080901 pmid: 24876114
[17]	Cirillo P, Gersch MS, Mu W, et al. Ketohexokinase-dependent metabolism of fructose induces proinflammatory mediators in proximal tubular cells[J]. J Am Soc Nephrol, 2009, 20(3):545-553. doi: 10.1681/ASN.2008060576 pmid: 19158351

指标	NA组(n=50)	MA组(n=51)	CA组(n=49)	F/χ²值	P值
性别[例(男/女)]	27/23	31/20	29/20	0.515	0.77
年龄(岁)	57.32±9.85	60.13±12.81	61.09±9.14	2.20	0.11
身高(cm)	165.44±13.79	168.17±8.25	167.96±7.65	1.46	0.23
体重(kg)	72.14±11.91	71.09±12.16	69.46±9.15	1.32	0.27
糖尿病病程(年)	7(3, 14)	10(4,18)	9(6,9)	2.17	0.34
高血压病程(年)	0(0,6)	0(0,8)	0(0,5)	0.53	0.77
身体质量指数BMI(kg/m²)	25.89±3.39	25.09±3.72	24.61±2.62	1.92	0.15
收缩压(mmHg)	129.5±15.14	134.4±18.37	158.32±24.36	46.01	0.00
舒张压(mmHg)	81.42±9.20	83.66±11.99	87.85±11.95	6.55	0.00

指标	NA组(n=50)	MA组(n=51)	CA组(n=49)	F/χ²值	P值
性别[例(男/女)]	27/23	31/20	29/20	0.515	0.77
年龄(岁)	57.32±9.85	60.13±12.81	61.09±9.14	2.20	0.11
身高(cm)	165.44±13.79	168.17±8.25	167.96±7.65	1.46	0.23
体重(kg)	72.14±11.91	71.09±12.16	69.46±9.15	1.32	0.27
糖尿病病程(年)	7(3, 14)	10(4,18)	9(6,9)	2.17	0.34
高血压病程(年)	0(0,6)	0(0,8)	0(0,5)	0.53	0.77
身体质量指数BMI(kg/m²)	25.89±3.39	25.09±3.72	24.61±2.62	1.92	0.15
收缩压(mmHg)	129.5±15.14	134.4±18.37	158.32±24.36	46.01	0.00
舒张压(mmHg)	81.42±9.20	83.66±11.99	87.85±11.95	6.55	0.00

指标	NA组(n=50)	MA组(n=51)	CA组(n=49)	F/χ²值	P值
UACR(mg/mmol)	0.89(0.52, 1.6725)	5.6(3.6,12.61)	70(44.175, 101.5)^*#	204.58	0.00
SCr(μmol/L)	66.49±15.36	67.24±15.87	381.36±150.9^*#	239.01	0.00
eGFR[ml/(min·1.73 m²)]	106.17±27.40	113.27±30.139	31.57±20.48^*#	329.50	0.00
FPG(mmol/L)	8.08(7.3,9.35)	9.12(7.61,12.89)	9.94(7.5,11.1)^*#	13.79	0.01
HbA₁c(%)	8.15(7.08,10)	9.6(7.8,11)	8.4(6.40,9.55)^*#	9.25	0.01
TG(mmol/L)	2.29±1.61	2.42±1.68	2.13±0.88	1.31	0.27
TC(mmol/L)	4.62±1.12	4.70±1.34	4.38±1.12	1.98	0.14
HDL-C(mmol/L)	1.01±0.27	0.99±0.30	0.97±0.25	0.52	0.60
LDL-C(mmol/L)	2.72±0.91	2.71±0.75	2.83±0.74	0.68	0.51
Cys-C(mg/L)	0.91±0.24	2.03±2.03	4.67±2.50^*#	67.64	0.00
UA(μmol/L)	291.72±3.06	318.86±96.059	415.71±142.82^*#	24.52	0.00
LP(α)(nmol/L)	8.05±3.06	57.83±14.47^*	139.71±47.00^*#	269.78	0.00

指标	NA组(n=50)	MA组(n=51)	CA组(n=49)	F/χ²值	P值
UACR(mg/mmol)	0.89(0.52, 1.6725)	5.6(3.6,12.61)	70(44.175, 101.5)^*#	204.58	0.00
SCr(μmol/L)	66.49±15.36	67.24±15.87	381.36±150.9^*#	239.01	0.00
eGFR[ml/(min·1.73 m²)]	106.17±27.40	113.27±30.139	31.57±20.48^*#	329.50	0.00
FPG(mmol/L)	8.08(7.3,9.35)	9.12(7.61,12.89)	9.94(7.5,11.1)^*#	13.79	0.01
HbA₁c(%)	8.15(7.08,10)	9.6(7.8,11)	8.4(6.40,9.55)^*#	9.25	0.01
TG(mmol/L)	2.29±1.61	2.42±1.68	2.13±0.88	1.31	0.27
TC(mmol/L)	4.62±1.12	4.70±1.34	4.38±1.12	1.98	0.14
HDL-C(mmol/L)	1.01±0.27	0.99±0.30	0.97±0.25	0.52	0.60
LDL-C(mmol/L)	2.72±0.91	2.71±0.75	2.83±0.74	0.68	0.51
Cys-C(mg/L)	0.91±0.24	2.03±2.03	4.67±2.50^*#	67.64	0.00
UA(μmol/L)	291.72±3.06	318.86±96.059	415.71±142.82^*#	24.52	0.00
LP(α)(nmol/L)	8.05±3.06	57.83±14.47^*	139.71±47.00^*#	269.78	0.00

指标	UACR	SCr	eGFR
Cys-C	0.204(0.012)	0.736(0.000)	-0.548(0.000)
UA	0.261(0.001)	0.377(0.000)	-0.460(0.000)
Lp(α)	0.455(0.000)	0.75(0.000)	-0.641(0.000)