The Value Of Lp-PLA2 And Cys-C In Early Diagnosis Of Diabetic Kidney Disease

ObjectiveIn recent years,with the increasing incidence of diabetes and diabetic kidney disease(DKD),the harm of diabetes and DKD is gradually recognized by people.Due to the lack of effective treatment and prevention means,it is considered as a major problem in the field of public health all over the world.In this paper,the application value of lipoprotein-associated phospholipase A2(Lp-PLA2)and cystatin-C(Cys-C)in early diagnosis of DKD was explored through the study of DKD,in order to find a new detection method for DKD.MethodsA total of 89 patients with type 2 diabetes who were hospitalized in the Department of Endocrinology,Taizhou People’s Hospital from January 2017 to December 2017 were selected.The age,height,weight,duration of diabetes,Lp-PLA2,UAER,Cys-C,urea nitrogen(BUN),creatinine(SCr),uric acid(UA),blood sugar,glycosylated hemoglobin(HDL-C)were collected.According to urinary microalbuminuria excretion rate(UAER),the patients were divided into three groups: normal proteinuria(NA),microalbuminuria(MA)and massive proteinuria(HA).The levels of plasma Lp-PLA2 and serum Cys-C were detected and analyzed statistically.Results(1)According to UAER,diabetic patients were divided into three groups,including30 cases in NA group,30 cases in MA group and 29 cases in HA group.Comparing the clinical indexes among the three groups,it was found that there was no statistical difference in baseline indexes such as age,sex,duration of diabetes,waist circumference,hip circumference,body mass index(BMI),overweight rate,obesity rate,fasting blood glucose,Hb A1 c,fasting c-peptide,systolic blood pressure,diastolic blood pressure,TG,HDL,LDL,and the prevalence of hyperlipidemia among the three groups(P>0.05).Compared with MA and NA groups,the prevalence of hypertension,TC,BUN,SCr and UA in HA group were significantly increased,while e GFR was decreased(P<0.05).The levels of Lp-PLA2 and Cys-C also increased with the increasing of UAER(P<0.05),and the level of Lp-PLA2 in MA group was significantly higher than that in NA group(P<0.05),indicating that the level of Lp-PLA2 started to increase in the early stage of DKD.(2)Pearson linear correlation analysis was used to analyze the relationship between Cys-C,Lp-PLA2 and clinical renal indexes.it was found that the levels of Lp-PLA2 and Cys-C in diabetic patients were positively correlated with UAER,BUN and SCr(P<0.05),and negatively correlated with e GFR(P<0.05).The level of Cys-C was positively correlated with UA(P<0.05),while the level of Lp-PLA2 had no correlation with UA(P>0.05).(3)NA group was set as group 1,MA and HA group as group 2.With this ordered grouping as dependent variable,SCr,BUN,Lp-PLA2,e GFR and Cys-C as independent variables,the multivariate logistic regression analysis showed that Lp-PLA2 was an independent influencing factor of DKD(OR=1.043,P=0.000).TC,TG,HDL,LDL,DBP,SBP were gradually dragged into the model for adjustment,the results did not change significantly.Lp-PLA2 was still an independent predictor of DKD(OR=1.086,P=0.005).(4)UAER≥20μg/min was considered as the boundary point,draw the ROC curve of Lp-PLA2,Cys-C and their combined detection was drawn to judge the predictive value of each index in diagnosing early DKD.The areas under the ROC curve(AUC)of Cys-C,Lp-PLA2 and their combination in detecting early DKD were 0.616,0.846 and0.888 respectively(p = 0.105;0.000;0.000).Cys-C single test could not diagnose DKD independently(p = 0.105,Yuden index=0.236).Lp-PLA2 single detection had the highest specificity(100%),slightly poor sensitivity(65%),and the best cut-off value was 108.28 ng/ml.Combined detection of Lp-PLA2 and Cys-C had the highest AUC,high sensitivity and specificity(80%,92.9%),which is superior to the diagnostic efficiency of single detection of Lp-PLA2.ConclusionThe levels of Lp-PLA2 and Cys-C could both reflect the degree of renal injury in DKD.Lp-PLA2 was obviously increased in early DKD stage and was an independent risk for early DKD.The combined detection of Lp-PLA2 and Cys-C could improve the diagnostic efficiency for DKD and provide a novel method for the early diagnose of DKD.