| Backgroud and objective The prevalence of DM worldwide is grow rapidly. DM has become one of the world’s major health problems. Diabetic kidney disease(DKD) is one of the more common complications of DM. Compared with other forms of chronic kidney disease(CKD), DKD has a higher bone mineral metabolism disorders(MBD) incidence. Studies have shown that CKD patients with elevated serum phosphate leve were correlated with the increased risk of death. Recently, it was discovered that DM is an inflammatory disease, insulin resistance and micro-inflammatory state play an important role in the development of DM and DKD. In DKD stage, the degree of inflammatory is more prominent than before. DM, systemic inflammation are risk factors for organism abdominal aortic calcification and severe fractures. As comparing to the individual with the same or only mild abdominal aortic calcification, severe abdominal aortic calcification has a higher cardiovascular mortality and risk of cardiovascular disease. This study was to analyze the serum calcium, phosphorus, interleukin 6(IL6),high-sensitivity C-reactive protein(hs CRP) levels and the correlation in patients with clinical dominant T2 DM with diabetic kidney disease(T2-d DKD).Methods Based on K/DOQI recommendations of 2007, 90 cases of type 2 diabetes mellitus(T2DM) patients were recruited from March 2014 to May 2015 in our hospital for this study. Based on the patient 2 times mean urinary albumin / creatinine ratio(ACR) leves,these subjects were divided into three groups, respectively DMN group [normal albuminuria group, 30 patients, ACR <30 mg/g Cr, 17 males and 13 females,mean age(54.03 ± 7.39) years old)], DKD1 group [microalbuminuria group, 30 patients, ACR30 ~ 300 mg / g Cr, 18 males and 12 females, mean age(52.10 ± 10.80) years old], DKD2 group [macroalbuminuria group,30 patients, ACR>300 mg/ g Cr, 10 males and 20 females average age(56.33 ± 9.00) years old]. Selected 30 cases of healthy persons as the control group at the same period [Con group, 12 males and 18 females, mean age(53.97 ± 10.28) years old]. All the subjects from each group were collected general information and test specimens in the morning( before treatments). The concentration of serum hs CRP was detected by immune turbidimetry; serum concentrations of IL6 by ELISA; the use of nephelometry and colorimetry were applied to measure ACR; glycated hemoglobin(Hb A1c) was measured by HPLC, and other experimental data was determined via the Hitachi 7600-020 and Olympus AU-400 automated instrument routinely. And all procedures were in accordance with the instructions strictly.Results There was no statistically significant difference in general information of subjects from each group. The e GFR in Proteinuria group was increased than others(P<0.05),the e GFR of Macroalbuminuria group was significantly lower than the respective( P<0.05). Subgroups of T2 DM with different albuminuria presence and severity, duration is also different between the groups, the more albumin in urine, the longer its duration. The contents of Hb A1 c in the groups of varying degrees of albuminuria increased as urinary albumin aggravation [ Hb A1 c was(8.87 ± 2.44)%,(9.27 ± 2.74)%,(11.04 ± 2.86)%, P <0.05 ], but there was not statistically significant between Microalbuminuria group [(9.27±2.74)%] and Normal albuminuria group [(8.87 ± 2.44)%]. Compared with Control group, in subgroups of T2 DM,serum calcium was reduced [(2.22 ± 0.19) mmol/l,(2.16 ± 0.14) mmol/l,(11.04 ± 2.86) mmol/l, and the Contorl group was(2.32 ± 0.11) mmol/l,P<0.05];and serum phosphorus[(1.16 ± 0.31) mmol/l,(1.42 ± 0.52) mmol/l,(1.98 ± 0.58) mmol/l, and the Control group was(1.08 ± 0.28) mmol/l], hs CRP [(4.82 ± 0.89) mmol/l,(8.46 ± 2.85) mmol/l,(13.09 ± 3.49) mmol/l, and the Control group was(2.46 ± 0.48) mmol/l], IL6 [(10.32 ± 4.19) mmol/l,(14.78 ± 4.34) mmol/l,(16.67 ± 6.62) mmol/l, and the Control group was(7.03 ± 2.15) mmol/l] were increased(P<0.05). In each subgroup of T2 DM, with the increase of albuminuria, hs CRP significantly increase [respectively(4.82 ± 0.89) mmol / l,(8.46 ± 2.85) mmol/l,(13.09 ± 3.49) mmol/l respectively, P<0.05], the calcium had downward trend [(2.22 ± 0.19) mmol/l,(2.16±0.14) mmol/l,(2.13±0.18) mmol/l respectively, P>0.05], phosphorus and IL6 had gradually increased trend. The difference levels of IL6 in the groups with albuminuria [(10.32 ± 4.19) pg/L,(14.78 ± 4.34) pg/L,(16.67 ± 6.62) pg/L, respectively] and in the group with no microalbuminuria [(7.03 ± 2.15) pg/L] was statistically significant, but no statistically significant between Macroalbuminuria group [(16.67 ± 6.62) pg/L] and Microalbuminuria group [(14.78 ± 4.34) pg/L]. The phosphorus in Macroalbuminuria stage [(1.98 ± 0.58) mmol/l] were statistical significance as compared with the Control group [(1.08 ± 0.28) mmol/l], Normal albuminuria group [(1.16 ± 0.31) mmol/l] and Microalbuminuria proteinuria group [(1.42 ± 0.52) mmol/l]. Serum phosphorus in Microalbuminuria group were positively correlated with hs CRP, IL6, Hb A1c(r values were 0.431, 0.384, 0.517 respectively, P<0.05). Serum phosphorus in Macroalbuminuria group were positively correlated with hs CRP, IL6, Hb A1c(r values were 0.825, 0.622, 0.683 respectively, P<0.01), but negatively with e GFR(r value was 0.600, P<0.01).Conclusion There were metabolism disorders of serum phosphorus in patients with T2-d DKD. Hs CRP,IL6,and Hb A1 c are factors of the rise and development of serum phosphorus in patients with T2-d DKD. |
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