| Objective:The patients with renal golmerular disease needed a glucocortic-oid therapy of larger daily doses and longer duration and impaired glucosemetabolism was one of the commonest adverse effects. Renal glomerulardisease patients with the normal glucose tolerance oral prednisone(0.8±0.11mg-1. Kg-1. d), and the incidence of insulin resistance and steroid diabeteswere25%and50%,respectively. Hyperglycemia could promote the progressof the kidney and cardiovascular events,which also affected the immunesystem only for A few days. It was an urgent clinical problem to prevent drugadverse reactions. We had known that high level of fibroblast growth factor21(FGF21) and adipocyte fatty acid binding protein (A-FABP) developedtype2diabetes after several years. The development of SD underwent aprocess as type2diabetics did. Here we investigated whether serum FGF21and A-FABP levels could predict the development of glucocorticoid induceddiabetes in patients with renal golmerular disease in order to screen thepredictors and change therapy treatment in induced phase to prevent the ofsteroid diabetes and improve prognosis.Methods:73patients with renal glomerular disease who were confirmed byclinica renal biopsy and in-hospital newly needing prednison therapy and foll-owed up in outpatient and the same period and selected the healthy checkup in15cases as control group from June2011to December2011at our hospitalwere recruited. Inclusion criteria:(1)Infection and inflammation in period offollowing up.(2) diabetes,acute kidney injury,chronic renal insufficiency,severe heart and liver disease,fatty liver.(3) using diuresis medicine,cyclospo-rine A, chlorpromazine, risperdal, sex hormones,β-blockerIII,calcineurininhibitors that effecting sugar metabolism.(4) recently taking vastatin or fibrates drugs. All subjects under the situation of steady diet were tested thelevels of fasting blood glucose(glucose oxidase method),fasting blood insulin(radiation immune method),and the level of blood glucose after2hours ofmeals (glucometer or glucose oxidase method) before glucocorticoidtreatment.The glucose tolerance test was required if fasting plasma glucosewas more than6.0mmol/L and/or2hour postprandial plasma glucose wasmore than7.8mmol/L. Caculate HOMA-IR according to the modal of HOMA.Detect the serum FGF21and A-FABP concentrations by enzyme linkedimmunosorbent assay and collect the data of albumin (ALB), blood fat,kidneyfunction, glycated hemoglobinA1c (HbA1c),24-hour urinary proteinquantitative and renal pathology materials. Patients were asked to monitorfasting and postprandial glucose a month every three to five days afterglucocorticoid treatment. According to the Chinese diagnosis standards oftype2diabetes in2010,the patients with renal golmerular disease were div-ided into normal glycometabolism (NGR) group, impaired glycolmetabolism(IGR) group and steroids diabetes mellitus (SD) group,and then baselineparameters were compared.Results:Of the73cases42was male and31was female, aged from13to76(37.5±15.7) years. The body mass index was23.92±3.00kg. m-2and mediancourse of disease was one month.Before prednisone treatment51patients werenormal glycometabolism and22patients were impaired glycometabolism.Prednisone dosage was0.77±0.10mg-1. Kg-1.d. The kidney pathological typesincluded Minimal change glomerulophay24cases, Membranous nephropathy28cases(stageâ… MN20cases, stage II MN1case,atypical membranous neph-ropathy7cases), IGA nephropathy12cases, Lupus nephritis3cases, andFocal segmental glomerulosclerosis3cases, and Small blood vessel inflamm-ation kidney damage, Minimal change IgM nephropathy, Mesangioproliferati-ve glomerulonephritis1case, respectively.â‘ The proportion of patients aftercorticosteroid therapy one month was NGR19cases(27.4%), IGR23cases(31.5%), SD31cases (41.1%). There was no statistically significant differencein the sex ratio, body mass index, waist-hip ratio, diabetes family history, fasting blood sugar, fasting insulin, insulin resistance index, high-densitylipoprotein cholesterol, triglycerides and serum creatinine among NGR,IGR,SD groups and healthy control group at the baseline. There was nostatistically significant difference in hormone daily average consumption,24hour urinary protein quantitative and renal vascular lesions among the threegroups (p>0.05). The incidence of SD in IGR gruop was higher than NGRgroup.(Basic NGR51cases,15cases (29.4%) developmented SD; IGR22patients:16cases (72.7%) developmented SD,p=0.001).â‘¡The concentrationsof FGF21and A-FABP in SD group were the highest and the incidence ofhypertension, glomerular sclerosis index and tubulointerstitium points in SDgroup were much higher than that of NGR group (p<0.05).The age,HbA1Cand postprandial glucose in SD group and IGR gruop were much higher thanthat of NGR group(p<0.05).â‘¢The serum FGF21was positively correlatedwith gender,age, systolic blood pressure, postprandial glucose,HbA1C,A-FABP,glomerular sclerosis index, tubulointerstitium points.(Correlation coefficient r=0.271～0.635,p<0.05) and was negativelycorrelated with TC,LDL(Correlation coefficient r=-0.248, r=-0.298,p<0.05)but had no correlation with BMI,FBG,HOMA-IR,TG,HDL,renal vascularlesions(p>0.05). We took FGF21as the dependent variable, above relevantindexes as the independent variables did multiple linear regression analysis,and Regression equation was y=-504.5+53.6XA-FABP+31.4Xglomerular sclerosisscore+93.8XHbA1C-7.1XTC.The results showed that A-FABP, glomerularsclerosis HbA1C and total cholesterol were all the independent related factorsof FGF21.â‘£The serum A-FABP was positively correlated with age, fastingglucose, postprandial glucose, HbA1C, FGF21(Correlation coefficientr=0.248～0.416,p <0.05) and was negatively correlated with TC,LDL(Correlation coefficient r=-0.237,r=0.294,p<0.05)but had no correlationwith gender,BMI,waist-to-hip ratio,systolic blood pressure, fasting insulin,HOMA-IR,TG,HDL,serum creatinine,glomerular sclerosis index,tubulointers-titium scores and renal vascular lesions.(p>0.05) We took A-FABP as thedependent variable, above relevant indexes as the independent variables did multiple linear regression analysis, Regression equation was y=1.975+0.002XFGF21+0.01Xage+0.537XHbA1C.The results showed that age, HbA1C andFGF21were all the independent related factors of A-FABP.⑤Logisticregression analysis showed if age increased10years and glomerular sclerosisintegral increased one score, the risk of occurred SD increased2.256timesand2.665times,respectively. Subjects with HbA1C(>5.6%),FGF21(>287.5pg/ml) and A-FABP(>5.86ng/ml) above the mean had ORs of7.994,7.234and4.889of developing Steroid Diabetes compared with below the mean atbaseline.Patients with FGF21above287.52pg/ml,A-FABP above5.83ng/mland both were higher at baseline had66.7%(22/33),61.1%(22/36),71.4%(15/21) incidence rates of SD, respectively.(P=0.721).Conclusions: The incidence of glucocorticoid induced glucose metabolicdisorders was41.1%in the derivative phase of renal glomerular disease. Thehigher Serum FGF21and A-FABP predicted the development of steroiddiabetes. If the serum FGF21was higher than287.52pg/ml or A-FABP higerthan5.83ng/ml,two-thirds patients developed SD,and two factors joint test didnot improve the predictive value of steroid diabetes. |
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