Correlation Between Serum ANGPTL3 Level And Diabetic Kidney Disease

Objectives To investigate the correlation between serum angiopogenin-like protein 3(ANGPTL3)and diabetic kidney disease(DKD),and to further explore the clinical value of ANGPTL3 in the early prediction of DKD.Methods A total of 256 eligible subjects were selected from Type 2 Diabetes Mellitus(T2DM)patients admitted to the Hebei Provincial People’s Hospital from March 2018 to November 2020.The general data(gender,age,height,weight)of the patients were collected.The patients were divided into control group(DM group)of 142 patients whose mean age 55.13±10.60 years old and diabetic kidney disease group(DKD group)of 114patients according to the 24h urine microalbumin level and the status of diabetic retinopathy,the DKD group was further divided into two subgroups:(1)73 patients whose mean age 57.52±13.02 years old in microalbuminuria group(30mg/24≤urinary microalbumin<300mg/24h;(2)41 patients whose mean age 58.17±10.51 years old in macroalbuminuria group(urinary microalbumin≥300mg/24h).All patients in DKD group were associated with diabetic retinopathy.Fasting venous blood and 24-hour urine were collected after informed consent of the patient.The serum levels of ANGPTL3,vascular endothelial growth factor A(VEGF-A),interleukin(IL-6),TNF-α(TNF-α)were detected by ELISA.Fasting blood glucose,estimate glomerular filtration rate,serum creatinine,blood nitrogen,blood lipid,and serum uric acid were measured with an automatic biochemical analyzer.The level of Hemoglobina1c was determined by high pressure liquid chromatography,and the level of microalbumin in urine was determined by immunoturbidimetry.SPSS 26.0 was used for statistics,and the significance level was all P<0.05.Results 1 Comparison of general clinical conditions between DM group and each subgroup of DKD group:serum creatinine,Hemoglobina1c and 24-hour urinary microalbumin levels in microalbuminuria group and macroalbuminuria group were significantly higher than those in DM group alone,and the differences were statistically significant(P<0.05).Further comparison between the two subgroups in the DKD group showed that,compared with the microalbuminuria group,the creatinine level in the macroalbuminuria group was significantly increased,and the differences were statistically significant(P<0.05).The levels of estimate glomerular filtration rate in the microalbuminuria group and the macroalbuminuria group were significantly lower than those in the DM group,and comparison between the two subgroups,the levels of estimate glomerular filtration in the macroalbuminuria group were significantly lower than those in the microalbuminuria group,and the difference was statistically significant(P<0.05).There were no significant differences in gender,age,body mass index,systolic blood pressure,diastolic blood pressure,albumin,cholesterol,triglyceride,low density lipoprotein cholesterol,high density lipoprotein cholesterol,fasting blood glucose,urea nitrogen,uric acid,total triiodothyrogenine,total thyroxine,insulin resistance index levels in each group(P>0.05).2 Comparison of serum levels of ANGPTL3,VEGF-A,TNF-αand IL-6 between DM group and DKD group:compared with DM group,the levels of Ang PTL3,VEGF-A,TNF-αand IL-6 in DKD group were significantly increased.Further comparison between subgroups showed that the levels of ANGPTL3,IL-6 and VEGF-A in macroalbuminuria group were significantly higher than those in microalbuminuria group,and the difference was statistically significant(P<0.05).3 Correlation analysis of serum ANGPTL3 and the following indicators:ANGPTL3 was negatively correlated with estimate glomerular filtration rate and total triiodothyronine(r_s<0,P<0.05),and had significant positive correlation with urinary microalbumin,serum creatinine,VEGF-A,TNF-αand IL-6(r_s>0,P<0.05).4 Analysis of influencing factors of serum ANGPTL3:Multiple linear regression analysis using ANGPTL3 level as dependent variable and serum creatinine,estimate glomerular filtration rate,total triiodothyronine,VEGF-A,TNF-α,IL-6,and urinary microalbumin level as independent variables showed that TNF-α,VEGF-A,IL-6,and urinary microalbumin were independent risk factors(B>0,P<0.05).5 Analysis of the influencing factors of the severity of DKD disease:The degree of microalbumin in urine was used as the dependent variable(normal albuminuria=1,microalbuminuria=2,and macroalbuminuria=3),and serum creatinine,estimate glomerular filtration rate,Hemoglobina1c,ANGPTL3,VEGF-A,TNF-α,and IL-6 were used as independent variables for ordered logistic regression analysis.The results showed that serum creatinine,estimate glomerular filtration rate,Hemoglobina1c,ANGPTL3 and VEGF-A had statistical significance in the model(P<0.05),among which serum creatinine,Hemoglobina1c,ANGPTL3 and VEGF-A were independent risk factors affecting the severity of urinary albumin(OR>0,P<0.05).6 ROC curve analysis of ANGPTL3 and VEGF-A in the diagnosis of DKD disease:ROC curve analysis showed that ANGPTL3and VEGF-A could be used to evaluate the early prediction of DKD.The area under the curve of ANGPTL3 and VEGF-A in the diagnosis of DKD was 0.895 and 0.806,respectively.In terms of accuracy,ANGPTL3(specificity 81.7%)had higher diagnostic value than VEGF-A(specificity 76.8%).Conclusions 1 In T2DM patients,serum levels of ANGPTL3,VEGF-A,IL-6 and TNF-αin DKD group were higher than those in DM alone group.2 In T2DM patients,urinary microalbumin,TNF-α,VEGF-A and IL-6 are the influencing factors of ANGPTL3.3Serum ANGPTL3 is an independent risk factor for urinary microalbumin level in DKD patients.4 Serum ANGPTL3 has certain diagnostic value for the occurrence of DKD.Figure 10;Table 6;Reference 164...