Value Of Urinary Albumin Combined With Alpha-smooth Muscle Actin In Diabetic Kidney Disease

Objective:To observe the changes of urine albumin(U-Alb)and human serum alpha-smooth muscle actin(α-SMA)secretion in patients with diabetic kidney disease,and to understand its role in diabetic kidney disease.Methods:The study chose 180 healthy controls without abnormal blood glucose and renal function and patients diagnosed with diabetes and diabetic kidney disease to underway questionaire collection,physical examination,laboratory examination,instrument examination,and determinated human serum alpha-smooth muscle actin(Use ELISA kit)in Department of Endocrinology,the first affiliated Hospital of Guangxi Medical University from October 2018 to December 2019.According to the diagnostic criteria for diabetes in Chinese prevention guidelines(2017 Edition)and the diagnostic criteria for diabetic kidney disease in Chinese prevention guidelines(2019 Edition),the researchers were divided into three groups:healthy control group,diabetes group,and diabetic kidney disease group.According to urinary albumin,subjects were divided into normal albuminuria group(<30mg/L),microalbuminuria group(30～300mg/L)and large albuminuria group(>300mg/L).According toα-SMA,subjects were divided into low-level groups(<3.12ng/m L),medium-level groups(3.12～20ng/m L),and high-level groups(>20ng/m L).The clinical characteristics,renal function andα-SMA concentration of three groups were compared by one-way ANOVA.Multiple linear regression was used to evaluate the relationship between U-Alb,α-SMA and other indexes.Multiple linear regression also was used to explore the risk factors of diabetic patients transformed to diabetic kidney disease.The Chi-square test was used to analyze the difference between U-Alb combined withα-SMA determination,U-Alb determination andα-SMA determination which are respectively in testing the positive rate of diabetic kidney disease.Results:There were significant differences in Hb A1_C,FPG,2h PG,e GFR,SCr,BUN,SUA,U-Alb,andα-SMA among the healthy control group,diabetes group,and diabetic kidney disease group(P<0.05).Hb A1_C,FPG and 2h PG were increased successively in healthy control group,diabetic group and diabetic kidney disease group(P<0.05).SCr,BUN,SUA,and U-Alb in the diabetic kidney disease group were significantly higher than those in the healthy control group and the diabetic group(P<0.05).The e GFR of the healthy control group was the highest among the three groups,the diabetic group followed,and the diabetic kidney disease group was the lowest(P<0.05).Theα-SMA in the diabetic group and diabetic kidney disease group were significantly higher than that in the healthy control group(P<0.05).There were statistically significant differences in Hb A1_C,FPG,2h PG,e GFR,SCr,BUN,SUA,α-SMA,the proportion of people with normal glucose tolerance,the prevalence of diabetes,and the prevalence of diabetic kidney disease among the normal albuminuria group,the microalbuminuria group and the large albuminuria group(P<0.05).Hb A1_C,FPG,2h PG,SCr,BUN,the prevalence of diabetic kidney disease were increased successively in the normal albuminuria group,microalbuminuria group and the large albuminuria group(P<0.05).e GFR,the proportion of normal glucose tolerance and the prevalence of diabeteswere were decrease successively in healthy control group,diabetic group and diabetic kidney disease group(P<0.05).SUA andα-SMA in the microalbuminuria group and the large albuminuria group were significantly higher than that in the normal albuminuria group(P<0.05).There were no significant difference in SUA andα-SMA between the microalbuminuria group and the large albuminuria group(P>0.05).There were statistically significant differences in U-Alb,e GFR,BUN,SUA,BUN,the proportion of people with normal glucose tolerance,the prevalence of diabetes,and the prevalence of diabetic kidney disease among the low-levelα-SMA group,medium-levelα-SMA group,and high-levelα-SMA group(P<0.05).With the increase ofα-SMA,U-Alb,e GFR,BUN,SUA showed an upward trend,and renal function gradually decreased(P<0.05).The prevalence of diabetes and the prevalence of diabetic kidney disease in the medium-levelα-SMA group and the high-levelα-SMA group were significantly higher than those in the low-levelα-SMA group(P<0.05).The proportion of normal glucose tolerance in medium-levelα-SMA group and high-levelα-SMA group were significantly lower than the low-levelα-SMA group(P<0.05).Multiple linear regression results of U-Alb,α-SMA and other indicators showed thatα-SMA was an independent influencing factor of U-Alb(F=234.597,P=0.000).With other factors unchanged,whenα-SMA increased,U-Alb showed an upward trend(Partial regression coefficient=1.096,95%CI=0.264～3.548).U-Alb is also an independent influencing factor ofα-SMA(F=2.547,P=0.011).With other factors unchanged,when U-Alb increases,α-SMA shows a downward trend(partial regression coefficient=0.025,95%CI=0.006～0.044).The relevant indicators were divided into the multiple linear regression model.The results showed that SCr,Hb A1_C,α-SMA were independent risk factors for albuminuria occured in diabetic patients(P<0.05).With the increase of DBP,SCr,Hb A1_C,α-SMA,the U-Alb in diabetic patients increased,so that the risk of diabetic patients progressed to albuminuria diabetic kidney disease increased(P<0.05).The partial regression coefficient and 95%confidence interval of partial regression coefficient about SCr,Hb A1_C,α-SMA in the multiple linear regression model of diabetic kidney disease are respectively(0.360,0.114～0.605),(7.942,-1.686～17.570),(1.906,0.264～3.548).With the increase of age,SCr,BUN,Hb A1_C,the e GFR of diabetic patients decreases,so that the risk of diabetic patients progressed to nonalbuminuria diabetic kidney disease is increased(P<0.05).The partial regression coefficient and 95%confidence interval of partial regression coefficient are(-1.197,-1.603～-0.986),(-4.090,-6.104～-2.077),(-0.087,-0.152～-0.022),(-0.088,-0.135～-0.041).The differences in the three diagnosis methods of diabetic kidney disease(U-Alb≥30mg/L,α-SMA≥3.12ng/m L,U-Alb≥30mg/L orα-SMA≥3.12ng/m L)were statistically significant(χ~2=8.213,P<0.05).The method using U-Alb combined withα-SMA has the highest positive rate among the three methods(P<0.05).Conclusion:Patients with diabetic kidney disease have higher U-Alb andα-SMA than healthy people and diabetes group.With the increase of U-Alb andα-SMA,renal function has a downward trend.SCr,Hb A1C,andα-SMA are independent risk factors for albuminuria in diabetic patients.Age,BUN,SCr,and Hb A1_Care independent risk factors for e GFR decline in diabetic patients,and up-regulation ofα-SMA expression can also be detected earlier in patients with normal albuminuria-diabetic kidney disease.The positive rate of combined detection of U-Alb andα-SMA is higher than single test,which has certain value for early diagnosis of diabetic kidney disease and is worthy of further clinical application.