Applications Of IMA And Albumin-adjusted Indexes Levels In Serum In T2DM And DN

Objective:Through the test of the content of serum IMA and albumin in case group and healthycontrols, in according to the formula to calculate the change of IMARs(IMARs=IMA toalbumin ratios), mean-IMA[mean-IMA=（individual serum albumin concentration/medianalbumin concentration of the population）×IMA value] and adj-IMA （adj-IMA=serumALB(g/L)×2.3+IMA(U/ml)100), statistical analysis of these indicators and therelationship between oxidative stress（TAS、SOD) and kidney damage, and comparativeanalysis on every index to evaluate the degree of T2DM patients with renal function injuryclinical application value.Study can be applied to the most valuable of T2DM and DN earlyassessment indicators.Methods：The study selected patients, from April to December2014of The First Hospital of JilinUniversity as the case group,50patients with T2DM, and105patients with DN. wecalculated the urinary albumin/creatinine ratio and divided the diabetic nephropathy （DN）group into groups with60microalbuminuria (micro-DN，UACR30-300mg/g), and45macroalbuminuria (macro-DN，UACR>300mg/g). From the hospital physical examinationof glucose metabolism, lipid metabolism, hepatic and renal function were normal, andeliminate the cardiovascular, liver, kidney and other organic diseases (45cases) as acontrol.Respectively to detect the serum glucose metabolism, renal function, IMA, TAS,SOD, CYSC, ALB, and urinary ALB, urinary CRE. The analysis was conducted by thestatistical product and service solutions (SPSS）program for Windows, version17.0. A pvalue of less than0.05was considered statistically significant. Results：1．Serum SOD, TAS in case group were significantly lower than the healthy controls,DN group was significantly lower than the T2DM group, including Macro-DN group ofserum SOD, TAS was significantly lower than that in Micro-DN group, the differences werestatistically significant (p<0.05).serum CYSC, BUN and CRE of DN group weresignificantly higher than healthy control group and T2DM group, while,serum ALB wassignificantly lower, the differences were statistically significant (p<0.05).serum CYSC, BUNand CRE of Macro-DN group were significantly higher than Micro-DN group, while,serumALB was significantly lower, the differences were statistically significant (p <0.05).Healthycontrols and T2DM group serum CYSC, BUN, CRE and ALB levels have no significantdifference (p>0.05). Serum IMA and IMARs of the case group were significantly increased,Compared with healthy controls, and macro-DN group significantly higher than themicro-DN group, the difference was statistically significant（p<0.05）. Compared withhealthy controls, mean-IMA and adj-IMA of DN group were significantly lower, andmacro-DN group was significantly lower than micro-DN group, the difference wasstatistically significant（p<0.05), While, the T2DM group were significantly higher than thatof healthy controls（p<0.05).2．Serum SOD and TAS had significant negative correlation with IMA and IMARs（p<0.05）, serum IMARs has the higher correlation with SOD and TAS. Serum SOD andTAS were significantly positively correlated with mean-IMA and adj-IMA（p<0.05).SerumCYSC had significant positively correlation with IMA and IMARs（p<0.05）, serum IMARshas the higher correlation with CYSC. Serum CYSC was significantly negative correlatedwith mean-IMA and adj-IMA（p<0.05).3．The ROC curves used to evaluate and compare the diagnostic performance of serumlevels of IMA and IMARs for differentiating between subjects with normal kidney function(UACR <30mg/g) and these with UACR>30mg/g (both with micro-andmacroalbuminuria).We observed a slightly, but statistically significant, larger area under thecurve for IMARs (0.868±0.042) in comparison with IMA (0.759±0.036). This indicatesthat IMARs has a slightly higher diagnostic potential in comparison with IMA.The optimumdiagnostic cut-off point maximizing the sensitivity and specificity of these parameters was 70.65U/mL for IMA (81.82%and41.67%, respectively) and1.69KU/g for IMARs (75.89%and81.42%, respectively).Through the ROC curves for serum IMA and IMARs fordifferentiating between diabetic patients with microalbuminuria (UACR30-300mg/g) andthese with macroalbuminuria (UACR>300mg/g). We observed a significantly larger areaunder the curve for IMARs (0.832±0.047) than for IMA (0.6902±0.052).The optimumdiagnostic cut-off point maximizing the sensitivity and specificity of these parametersrevealed that the IMA had78.84%sensitivity and55.71%specificity for a cut-off of71.05U/mL. The sensitivity and specificity of IMARs for a cut-off of1.64KU/g are81.69%and68.33%, respectively.Conclusion:1. The levels of serum IMA and IMARs were elevated in patients of T2DM andDN,with the increased of oxidative stress,while the levels of serum TAS and SOD werereduced.2. IMARs had the best correlation of oxidative stress strength and degree of kidneydamage,with the patients of T2DM and DN,among serum IMA and albumin-adjustedindexes(IMARs, mean IMA and adj-IMA).3. Serum IMARs in assessing the degree of renal injury patients with DN（Micro-DNVS Macro-DN）, the sensitivity and specificity were better than that of the IMA.