The Impact Of Neutrophil Gelatinase Associated Lipocalin Level With Diabetic Nephropathy Patient

BackgroundNeutrophils enzyme related lipid carrier protein gelatin peroxidase negative particles from neutrophils extracted a kind of glycoprotein.With surrounding inflammation,tumor in recent years,ischemia reperfusion,abnormal lipid metabolism,insulin resistance,such as multiple directions and endocrine for NGAL the deepening of the research,gradually from multiple tissues and organs in the study found that NGAL messenger RNA in the steady-state level expression,such as kidney,uterus,salivary glands,bone marrow,gastric,prostate,colon,appendix,trachea and fetal spleen.NGAL and kidneys,has the close relation between renal injury and diabetes.With the course of development of diabetic nephropathy,glomerular dysfunction progression,renal tubular membrane integrity is destroyed,matrix NGAL activity and content on the increase with massive proteinuria was positively correlation,shows a large amount of NGAL or of urine can indirectly reflect the seriousness of the degree of pathological changes of diabetic nephropathy.So by screening to detect high-risk NGAL protein in the urine of patients with active to complete on the early diagnosis of DN patients,with no damage,low cost,convenient testing,good repeatability,high clinical application value of better detection index for clinical outcomes for patients with diabetic nephropathy.Objective:We analyzed the Neutrophil gelatinase associated lipocalin(NGAL)and other impact factors changes in type 2 diabetes mellitus(T2DM)patients retrospectively.So that we can get to know this clinical value of the indicator for judging progress to T2 DM Diabetic Nephropathy(DN).MethodsContinuity,retrospectively collect patient data in our hospital between January 1,2012 to 2013 January 1,with the first test of admission T2 DM duration> 10 years or duration of less than 10 years it has been the progress of patient data in diabetic retinopathy.All patients were admitted to hospital after registration Generally,access to age,medical history,genetic history,smoking history,Mean arterial pressure(MAP),Body Mass Index(BMI),Triglyceride(TG),Total cholesterol(TC),Low density lipoprotein-cholesterol(LDL-C),hemoglobin Alc(Hb Alc),Prothrombin Time(PT),Fasting C peptide(FCP),Fasting blood glucose(FBG),Serum creatinine(Scr),Quantitative test of 24 h urinary protein(QT24UP),Urinary albumin excretion rate(UAER),Hypersensitive C-reactive protein(hs-CRP),Homocysteine(Hcy),Urinary albumin-to-creatinine ratio(UACR),Body Mass Index(BMI),Mean arterial pressure(MAP),Cytokeratin 19(Ck-19)and NGAL levels.All patients were followed up for 2 years if conventional recording progress to clinical stage DN.And based on the results of follow-up,patients were divided into merger will be included in clinical DN group and unconsolidated clinical DN group.Comparison between the two patient groups difference data;using multivariate logistic regression analysis were independent risk factors affect the outcome of the draw;assess NGAL by ROC curve in patients with a poor prognosis for the DN The predictive value and critical value;and based on its prediction of critical value,above the threshold DN patients were divided into groups and the group,two groups of patients using KM curve to verify whether the incidence of adverse prognostic differences,to identify patients at high risk of DN.ResultsAfter inclusion,exclusion and exclusion criteria were collecting clinical data of 74 patients,a total of 70 patients completed the follow-up.18 Cases of DN patients,52 patients in clinical DN group did not merge.Comparison between two groups of patients data show: hypertension,smoking history,BMI,significant differences in LDL-C,Hb Alc,FCP,FBG,Scr,QT24 UP,Hcy,,NGAL,a total of 12 indicators of the presence of CK 19-(P all <0.05);Logistic regression model suggests that: higher levels of BMI,higher levels ofHb Alc,higher levels of QT24 UP,higher levels of CK-19,higher levels of NGAL is the inclusion of patients 2 years of progress to be independent risk factors for clinical DN stage(P <0.05);draw NGAL as an independent risk factor for poor prognosis evaluation of ROC curve area under the curve(AUC)was 0.811,95% confidence interval between(0.769-0.856)between.NGAL best predictive value 75.80 ng / ml,the sensitivity was71.70%,a specificity of 82.58%.Drawing and KM survival curves in patients also demonstrated above 75.80 ng / ml have a higher risk of a poor prognosis(80.00% vs 8.00%,χ2 = 10.671,P <0.05).ConclusionSerum NGAL is important for early diagnosis of clinical DN patients,assessing prognosis,especially to identify high risk and so on.