The Relationship Between Senile Type2Diabetic Patients With Urinary Albumin And Lipoprotein (a)

Background:Diabetic nephropathy(DN) is a kind of serious chronic complication caused by diabetes mellitus(DM), it is a manifestation of DM Systemic microangiopathy. The pathogenesis of DN has not yet entirely clear, maybe related with renal homodynamic changes caused by sustained hyperglycemia, abnormal glucose metabolism, fat and protein metabolism. The clinical features are Proteinuria, Progressive renal dysfunction, Hypertension and hydrosarca, Serious kidney failure will appear at the late age is one of the major causes of death for patients with DM. It is not obvious at the early age and lack of obvious clinical symptoms in the early age, once in the age of clinical proteinuria, it is develops rapidly, easily develops into chronic renal insufficiency. Therefore, there is an urgent need to solve the problem how to diagnose early and treat timely. The discharge amount of urinary microalbumin(UMAU) and urinary creatinine(Ucr) is affected by many factors, but it keeps relative stabilization by individual. By observe urinary microalbumin/creatinine ratio (UACR) we can diagnose DM early renal damage more accurately, to avoid one-sidedness caused by observe a certain target singly. Most DN patients suffered from dyslipidemia, the researches of the relationships between the Lipoprotein(a)[Lp(a)] and type2diabetes mellitus (T2DM) mainly concentrated on the relationships between Lp(a) and T2DM, and the result are varied, the research about Lp(a) and T2DM microangiopathy are less, so we to analyze the relationship between the UACR and Lp (a) in elderly T2DM patients.Methods:Part I:From2011January to2012October period, retrospective analysis of clinical cases in106cases of T2DM patients and30cases of non DM in healthy people in our Hospital, the following criteria:diagnosis and classification of DM according to the2011March American Association of Clinical Endocrinologists released the new DM guidelines for the diagnosis and treatment:the age of the patients was over60, exclusion of chronic liver disease, chronic kidney disease, connective tissue disease, cancer and other diseases, and no acute complications of DM and acute and chronic infection. The patients were grouped as follows:50cases of diabetic nephropathy group (UACR≥30mg/g), including30males and20females, mean age72.5(64.0,78.3) years old.56cases of non-diabetic nephropathy group (UACR<30mg/g), male29cases and female27cases, mean age70.5(66.0,75.6) years old. Non diabetic control group of30cases, male17cases and female13cases, mean age67.0(64.0,78.5) years old. Observed for the duration of diabetes, blood pressure, three three triacylglycerol(TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), apolipoprotein Al (Apo-Al), apolipoprotein B (Apo-B), Lp (a); renal function [urea, blood serum creatinine,(Scr), uric acid], fasting plasma glucose (FPG), glycosylated hemoglobin (HbAlC)and fasting C-peptide(FCP). Height, weight and body mass index (BMI), UMAU, Ucr and Calculation of UACR=UMAU*1000/(Ucr*0.113), and the block with the index by using statistical analysis.Part II:We evaluated the efficacy and safety of the urinary microalbumin and lipoprotein (a) among elderly type2diabetic patients through a systematic literature review. We selected the literature published between1989.1and2012.12which met the inclusion criteria. The computer retrieval databases included PubMed (included MEDLINE), CNKI, Ovid, Wanfang, EMBASE and Science Direct, All search strategy were in accordance with the requirements of the Cochrane Collaboration Handbook.Results:The topics were included136cases of patients.including50cases of diabetic nephropathy patients (UACR≥30mg/g),30males,20females, Average age72.5(64.0,78.3),56cases of non-nephrotic grouppatients(UACR<30mg/g),29males,27females, Average age70.5(66.0,75.6), Non-diabetic control group30cases,17males,13females, Average age67.0(64.0,78.5). There are136patients who finally accomplished all research. The result shows that (1) Lp(a) level in diabetic group was significantly higher than that in non-diabetic group, mean while Lp(a) level was higher in diabetic nephropathy group than that in non-nephrotic group;(2) Lp(a) and UACR had no significant correlation between the normal control group and non-diabetic nephropathy group,while Lp(a) and UACR had positive correlation in diabetic nephropathy group (r=0.363, P<0.01);(3) In elderly patients with type2diabetes, Lp (a), FCP, course of disease as the independent factors associated with UACR.Conclusions:Lp(a) and UACR had positive correlation in diabetic nephropathy group, and Lp (a) was one of the independent factors affecting UACR level, so Lp (a) level can indirectly reveal the kidney damage in type2diabetic patients.