Assosciation Between Serum Resistin Levels And The Insulin Resistance In Patients With Diabetic Nephropathy

Objective：As lifestyles change, diabetes have rapidly increased in both developedand developing countries year by year. Diabetic kidney disease （DKD）is alate complication of diabetic. Diabetic nephropathy accounts for about15%-60%in type2diabetes（T2DM）, and accounts for about1/3in patients withend-stage renal disease. Diabetic nephropathy has becom the main cause ofonset in patients with chronic renal insufficiency. The data indicate thatinsulin resistance（IR）is the central link of the metabolic syndrome and theoriginal motivation and pathogenic basis of diabetes, hypertension andmetabolic disorder. Insulin resistance could increase the morbidity andmortality of diabetic nephropathy in patients with cardiovascular disease, and promote the progression of renal disease. However, resistin specificallysecreted by fat cells and it is a new link that linked metabolic signals,inflammation and atherosclerosis. It may be involved in insulin resistance,and play an important role in diabetic kidney disease. In this study, throughdetecting serum resistin, fasting plasma glucos（eFPG）, fasting insulin（Fins）,insulin resistance index （HOMA-IRI）, low density lipoprotein（LDL-C）,endogenous creatinineclearance rate（Ccr）of diabetes and healthy controlgroup, to analyze the correlation between serum resistin levels and thevarious indexes, and to explore the relationship between serum resistin levelsand insulin resistance（IR）in patients with diabetic kidney disease（DKD）.Methods:（1）63cases of patients with typeⅡdiabetes were selected from theDepartment of Endocrinology and Nephrology of Qingdao MunicipalHospital in the period June2011to2011September（31males and32females, Age:52~72years, mean age:61years）. All groups are asfollows: A-group, the diabetic group（Urinary mAlb＜30mg/24h）including20patients（10males and10females, Age:52~70years, mean age:62.2years）. B-group, microalbuminuria group（30mg/24h≤Urinary mAlb＜300mg/24h）including22patirnts（10males and12females, Age:56~70years, mean age:63.4years）. C-group, clinical proteinuria group（UAER ≥300mg/24h）including21patients（11males and10females, Age:58~72years, mean age:64.2years）. D-group, the normal healthy control groupincluding21patients（Age:51~69years, mean age:60.4years）. Thediagnosis of type2diabetes were in line with the diagnostic criteria fordiabetes which was established by the Diabetologist Committee of WHO in1999. All cases were not suffering from a variety of acute and chronicinfectious inflammation. All cases were not suffering from serious heartdisease such as acute myocardial infarction, unstable angina, severe cardiacdysfunction. All cases were not suffering from liver function damage. Allcases have not been used statins and angiotensin converting enzyme inhibitor（ACEI）.（2）Hitachi7070automatic biochemical analyzer was usedtodetermine blood glucose, LDL-C and Cr. Sandwich enzyme-linkedimmuno-sorbent assay （ELISA） was used to determine the resistin.Time-resolved fluoroimmunometric assay（TRIFA）was used to determinefasting plasma insulin （FINS）. Radioimmunoassay was used to determineurinary albumin excretion rate （UAER）. Steady-state model was used toCalculate HOMA-IRI: HOMA-IRI=FINS×FPG/22. The method ofcalculating endogenous creatinine clearance: e-GFR=[Weight (kg)×(140-age)×88.4]/[72×of Cr (mmol/L)]（female×0.85）.To compare thedifference of FPG, HbAlC, UAER, HOMA-IRI and serum resistin level between all groups, and to analyze the correlation between resistin andindicators.（3）All data were analyzed with SPSS l7.0statistical software.Measurement data are expressed as mean±standard deviation（X±s）. T testwas used for the comparison between groups. Using Pearson correlationcoefficient to evaluate the correlation of various indicators. P＜0.05wasconsidered statistically significant.Results:（1）There were no significant differences among the four groups ingender, age and BMI（P all＞0.05）.（2）Compared with the normal controlgroup（D-group）, the levels of Serum Resistin, UAER, LDL-C, HbAlC,HOMA-IRI significantly increased in A, B, C groups（the diabetic groupand DKD groups）, P all＜0.05. While the levels of Ccr significantly reduced（P＜0.05）.（3）Compared with A group, the levels of Serum Resistin,UAER, LDL-C, HbAlC, HOMA-IRI significantly increased in B and Cgroup（sP all＜0.05）. While the levels of Ccr significantly reduce（dP＜0.05）.（4）Correlation analysis showed that the levels of Serum Resistin in type2diabetic patients with nephropathy were positively correlated with the levelsof HOMA-IRI, UAER, LDL-C, HbAlC（The respective r is0.72,0.09,0.54,0.73）, but it was negatively correlated with Ccr（r=－0.89）. Conclusion:1. The levels of serum resistin in clinical proteinuria group（C-group）were significantly higher than that in the diabetic group（A-group）andmicroalbuminuria group （B-group）, indicating that resistance play animportant role in the process of type2diabetes’s and microalbuminuria’sformation and development.2. The levels of Serum Resistin werepositively correlated with the levels of HbAlC, LDL-C and IRI, indicatingthat the higher the levels of blood glucose and blood lipid, the the moreserious insulin resistance, thus the higher the concentration of serum resistin.It further shows that serum resistin was closely related to the insulinresistance of DKD patients. Detecting serum resistin changes in patients withT2DM might reflect their renal lesions to some extent.3. The levels ofSerum Resistin was negatively correlated with Ccr. It further shows thatserum resistin may be an important indicator of kidney damage.