Effects Of Blood Glucose Fluctuations And NLR On Diabetic Nephropathy

Background and ObjectiveHyperglycemia is the main clinical manifestation and basic characteristics of diabetic patients.Long-term and persistent hyperglycemia can cause a variety of chronic complications,which not only affect the quality of life of diabetic patients,but also lead to disability and death of diabetic patients.In the past,clinical workers paid more attention to the elevation of blood glucose level,but less attention to the fluctuation of blood glucose.In recent years,with the increase of blood glucose monitoring techniques and the improvement of monitoring level,more accurate and comprehensive blood glucose values can be obtained in clinical work.Many laboratory data and clinical research,according to the results of Type 2 diabetes(Type 2 diabetes mellitus,T2DM)in patients with chronic complications development is not only related to the rise in fasting and postprandial blood glucose levels,and blood sugar fluctuation correlation,blood sugar volatility could lead to an increased risk of diabetes complications,become an independent risk factor for diabetic chronic complications.The increase of neutrophil count represents the activation of the inflammatory response and reflects the non-specific inflammatory state in the body.Lymphocytes,as a kind of subgroup of leukocytes,mainly reflect the immune state of the body.In the state of inflammation,the number of neutrophils increased and the number of lymphocytes decreased,and the neutrophil-to-lymphocyte ratio(NLR)was significantly changed,with higher stability and representativeness.As an emerging inflammatory marker,NLR is simple,easy to measure and cost-effective.In recent years,it has been used as an inflammatory marker for a variety of chronic diseases.Diabetic nephropathy(DKD)is a common chronic microvascular complication in Diabetic patients.Early diabetic nephropathy has no obvious symptoms,and is only manifested as a slight increase in urinary protein.With the progress of the disease,a large amount of proteinuria and renal injury may occur,which eventually leads to renal failure.In recent years,with the in-depth understanding of the mechanism of diabetic nephropathy,it has been found that low level inflammation mediated by natural immunity is the pathophysiological basis for the occurrence and development of DKD.Therefore,as a manifestation of inflammatory state,NLR may be correlated with DKD to some extent.Retrospectively analyzing the clinical data of 339 patients with type 2 diabetes mellitus,type 2 diabetes mellitus patients with blood sugar fluctuation,the relationship of the NLR and DKD,to emphasize the important role of prevention and control of blood sugar stable in DKD,and analyze the cause of DKD other risk factors,for the early diagnosis and treatment of DKD offers technical support of laboratory diagnosis and intervention measures.Materials and Methods1 MaterialsChoose between January 2018 and July 2019 in the second affiliated hospital of zhengzhou university endocrinology hospitalization and wearing a continuous glucose monitoring system of the 339 cases of patients with type 2 diabetes as the research object,the general clinical data collected on admission in patients with:including gender,age,duration of diabetes,measuring its height,weight,calculate body mass index;Baseline laboratory indicators of the subjects were collected:fasting blood glucose,glycosylated hemoglobin,blood routine,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol and urinary microalbumin-creatinine ratio,and Mean amplitude of glycemic excursions(MAGE)and NLR were calculated.The diagnosis of type 2 diabetes conforms to the Chinese guidelines for the prevention and treatment of type 2 diabetes(2017 edition):typical diabetes symptoms(polydipsia,polydipsia,polyuria,weight loss),random venous plasma glucose level≥11.1mmol/L;Or fasting blood glucose≥7.0mmol/L;Or 2h≥11.1mmol/L with glucose loading.The diagnosis of diabetic kidney disease reference China diabetic kidney disease prevention and treatment of clinical guidelines:the glomerular filtration rate(Glomemlar filtration rate,GFR)falls below 60 ml/(min × 1.73 m2)and Urine(or)urinary albumin/creatinine ratio(Urine albumin/creatine thewire,UACR)more than 30 mg/g persists for more than 3 months.Exclusion criteria:(1)hypertension;(2)systemic or urinary tract infection;(3)patients with cardiac insufficiency,tumor,severe cardiovascular and cerebrovascular diseases,or liver and kidney insufficiency;(4)acute complications of diabetes,such as diabetic ketoacidosis and hyperosmotic coma,occurred in the past 1 month;(5)pregnant and lactating women;(6)diseases of rheumatic immune system and blood system;(7)proteinuria is caused by other causes such as primary kidney disease.2 Statistic AnalysisSpss21.0 statistical software was used to analyze the data.The measurement data were expressed as mean±standard deviation(x±s),and the counting data were expressed as case number and percentage(n,%).Two independent samples t-test and non-parametric test were used for the comparison between measurement data sets,and the chi-square test and Fisher’s exact probability method were used for the enumeration data.Multivariate regression analysis was performed using binary Logistic regression analysis.The ROC curve was used to evaluate the predictive value of MAGE and NLR to DKD.P<0.05 was considered statistically significant,and P<0.01 was considered statistically significant.Results1 The differences in diabetes course,fasting blood glucose,hbalc,cholesterol,NLR,UACR between the normal group and the abnormal group were statistically significant(P<0.05),in which the course of disease(OR=1.043,95%ci:1.009-1.078)and cholesterol(OR=1.274,95%ci:1.023-1.587)were independent factors affecting the fluctuation of blood glucose.2 Urine trace albumin/creatinine ratio of normal and abnormal urine trace albumin/creatinine ratio group compared with age,duration,low density lipoprotein cholesterol,NLR,MAGE,statistically significant differences(P<0.05),in which the course(OR=1.063,95%CI:1.024 1.103),NLR(OR=1.765,95%CI:1.2982.401),the MAGE(OR=1.410,95%CI:1.211 1.642)is the independent factors affecting UACR.3 The ROC curve determined that the optimal cutoff values of MAGE and NLR were 4.095 and 2.165,respectively,the MAGE’s sensitivity and specificity were 83.8%and 48.5%,and the NLR’s sensitivity and specificity were 53.5%and 81.1%,respectively.Conclusions1 In T2DM patients,the fluctuation range of blood glucose increased with the extension of disease course and the increase of cholesterol.2 In T2DM patients,with the extension of the course of disease,the increase of MAGE and the increase of NLR,DKD is more likely to occur,and MAGE and NLR have certain clinical value in evaluating whether DKD occurs in T2DM patients,and may be a clinical indicator to predict DKD.