| Objective:The relationship between serum soluble urokinase plasminogen activator receptor(suPAR)and diabetic kidney disease staging in patients with type 2 diabetes mellitus(DKD)was investigated.Moreover,we studied the relationship between serum suaPAR and estimated glomerular filtration rate(eGFR),urinary albumin creatinine ratio(UACR),and other clinical indexes,in order to provide new hematological biological markers for early diabetic nephropathy,and to provide the basis for diagnosis,intervention and treatment of diabetic nephropathy.Methods:This study is a cross-sectional study.106 patients with type 2 diabetes mellitus and 33 controls were divided into 5 stages according to mogensen criteria,from January 2016 to December 2017.Clinical data of all subjects were collected,fasting blood and urine samples were collected for biochemical examination.Serum suPAR was determined by ELISA.Results:The average concentration of serum suPAR in all subjects was 595.10±436.99 pg/ml,the median was 450.17 pg/ml,the P25 was 351.83 pg/ml,the P75 was 711.50 pg/ml,and the range was from 130.17 to 3496.83 pg/ml.There was no significant difference in the concentration o f suPAR between different sex groups(P>0.05)and different BMI groups(P>0.05),but it was related to the age(P<0.05)and the course of diabetes mellitus(P=0.001).With the development of diabetic nephropathy,the level of serum suPAR began to increase gradually after the second stage of diabetic nephropathy,and the serum suPAR level of patients with different stages be gan to show statistical difference,compared with the control group and the diabetic group after the third stage of diabetic nephropathy.The level of serum suPAR in the subject was related to the presence of hypertension(P<0.01),but not to duration of hypertension(P>0.05).Meanwhile,the level of serum suPAR had no relation with coronary heart disease(P>0.05),fatty liver(P>0.05),but had relation with cerebral infarction(P<0.01)and atherosclerosis(P<0.01).There were significant differences in serum suPAR levels between the subjects who used insulin(P<0.01),insulin procreant(P<0.01)and metformin(P<0.01).However,there was no association between serum suPAR level and those taking acarbose(P>0.05),ARB/ACEI(P>0.05),calcium antagonists(P>0.05),β receptor blocker(P>0.05)and statins(P>0.05),respectively.Serum suPAR levels were correlated with systolic blood pressure(r=0.277),but not diastolic blood pressure(r=0.141),and heart rate(r=0.031).In the correlation analysis with blood routine indexes,serum suPAR level was correlated with RBC(r=-0.611),hemoglobin(r=-0.588),lymphocyte(r=-0.381),neutrophil/lymphocyte ratio(r=-0.527),but it was not associated with leukocyte(r=-0.162),neutrophile granulocyte(r=0.081),monocyte(r=-0.17),eosinophile granulocyte(r=-0.077),basophil(r=-0.175)and platelet(r=-0.07).In the analysis of the correlation with urine test indexes,serum suPAR level was closely associated with urinary microalbuminuria(r=0.679),urinary creatinine(r=0.316),urinary creatinine,urinary protein(r=0.338),total 24 hour protein(r=0.394)and urine specific gravity(r=-0.400),but not urine pH(r=-0.138),and urinary NAG enzyme(r=0.192).In the analysis of quantitative urine routine indexes,the concentration of suPAR in serum was correlated with urinary protein(r=0.731)and occult blood(r=0.277),but not urinary leukocyte(r=0.075),urine glucose(r=-0.135),and urine acetone bodies(r=-0.191).In the analysis of blood biochemical indexes,serum suPAR levels were associated with total bilirubin(r=-0.390),direct bilirubin(r=-0.407),indirect bilirubin(r=-0.374),low-density lipoprotein(r=-0.232),retinol binding protein(r=-0.570),creatinine(r=0.663),urea(r=0.309),uric acid(r=0.243),and eGFR(r=-0.646),but not triglyceride(r=-0.133),total cholesterol(r=-0.057),high density lipoprotein(r=0.061),blood glucose(r=0.133),albumin(r=0.176),globulin(r=-0.040),fasting insulin(r=-0.038),and fasting c peptide(r=-0.136).Other clinical risk factors were considered when multivariate regression analysis was carried out,the level of serum suPAR was positively correlated with the levels of UACR(β=-0.874),urinary microalbumin(β=-0.868)and serum creatinine(β=-1.147),but negatively with eGFR(β=-3.614)and hemoglobin(β=-2.840),respectively.ROC analysis showed that the best point of suPAR for indicating early diabetic nephropathy was 499.33 pg/ml,the corresponding AUC was 0.763(95%Ci 0.663-0.863),the Uden index was 0.497,the sensitivity was 0.547,the specificity was 0.950.Conclusions:The level of serum suPAR is independently associated with the early stage of diabetic nephropathy and correlated with its subsequent stages.It may be a potential biomarker for diagnosing the early stage of and tracking diabetic kidney disease.The level of serum suPAR is independently associated with the early stage of diabetic nephropathy and correlated with its subsequent stages.It may be a potential bio marker for diagnosing the early stage of and tracking diabetic kidney disease. |
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