The Levels Of Feuin-A In Patients With T2DM And The Correlation With Diabetic Nephropathy

Objective: To investigate the relationship between the levels of urinary and plasma Fetuin-A of patients with type 2 diabetes,as well as the Fetuin-A level from different crowd such as normal subjects,type 2 diabetes mellitus and type 2 diabetic nephropathy.Methods:1.Choose type 2 diabetes(T2DM)from November 2015 to June 2016 in the department of endocrinology of Affiliated Hospital of North Sichuan Medical College and outpatient.All patients met diagnostic criteria of 2010 ADA T2DM standard guidelines.According to urinary albumin and creatinine ratio(Albumin to creatinine ratio,ACR),T2 DM patients were divided into 3subgroups: ACR < 30?g/mg into normal albuminuria group(NA),with 20 cases,30?g/mg? ACR<300?g/mg into microalbuminuria group(MA),with17 cases,ACR?300?g/mg into macroalbuminuria group(OA).Over the same period,with 18 cases,20 cases of health examination in our hospital as normal control group(NC).2.Using enzyme-linked immunosorbent assay(ELISA)to measure the plasma and urinary fetuin A(Fetuin-A)concentration,collecting and recording all the subjects' body mass index(BMI),waist hip ratio,systolic blood pressure(SBP),diastolic blood pressure(DBP),ACR,urinary Alpha-1microglobulin(?1-MG)and creatinine ratio,urinary albumin,fasting blood glucose(FPG),glycosylated hemoglobin(Hb A1c)and insulin resistance index(HOMA-IR),total protein,albumin,blood urea nitrogen(UN),serumcreatinine(Cr),total cholesterol(TC),triglycerides(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),C reactive protein(CRP),and other clinical indicators as well.Complete abdominal ultrasonography and color doppler ultrasound screening.3.Using SPSS 19 statistical software for statistical analysis.The normal distribution data was expressed by x ±s,non normal distribution with a median ± four percentile interval.After the variance homogeneity test and the normality test,the independent sample t test was used between the two samples,and the one-way ANOVA was used to analyze the number of samples.The non-normal distribution was nonparametric,correlation analysis using Pearson correlation analysis,multiple factors using multiple linear stepwise regression analysis,the positive rate of comparison using the2? test.The diagnostic efficiency of different renal injury staging was calculated by using the receiver characteristic curve(ROC),and the area under the curve as well as the threshold was measured,and the sensitivity and specificity of the diagnosis were calculated.P < 0.05 for the difference was statistically significant.Results:1.T2 DM group FPG,HbA1 c and CRP were higher than NC group,and the difference was statistically significant(P <0.05).But between them there was no statistically significant in age,gender,waist-hip ratio,BMI,BP,Cr,UN,TG,TC,LDL-C and HDL-C.2.T2 DM group plasma Fetuin-A and urinary Fetuin-A were higher than NC group,and the difference was statistically significant(P <0.05).According to the level of ACR,T2 DM group that was divided into NA,MA and OA three subgroups,were higher than NC group(P < 0.05),and thedifference was statistically significant between NA group and OA group(P <0.05).Urinary Fetuin-A levels of NA group,MA group and OA group were significantly higher than NC group(P < 0.01),and there was statistically significant difference between MA group,OA group and NA group(P < 0.01),as well as MA group and OA group(P < 0.05).Plasma Fetuin-A and urinary Fetuin-A had a gradually increasing trend in NC,NA,MA and OA groups.3.Plasma Fetuin-A and urinary ACR were positively correlated(P <0.05).Urinary Fetuin-A had positively correlation with SBP,FPG,HbA1 c,urinary ?1-MG,urinary ?1-MG and creatinine ratio,ACR,and plasma Fetuin-A(P < 0.05),as well as negatively correlation with total protein,blood albumin(P < 0.05).4.In group T2 DM,the logarithm ACR was converted to normal distribution,with In(ACR)as the dependent variable,the relevant clinical indicators as variables in multiple linear regression analysis showed that disease duration,HbA1 c,?1-MG and creatinine ratio,urinary Fetuin-A was an independent risk factor of In(ACR)(P < 0.05).5.Positive rate result analysis: The positive rate of urinary ?1-MG and urinary Fetuin-A was significantly higher than those of the other one urine samples to test diabetic nephropathy(P < 0.05).6.Derived from the ROC curve: The area under the curve of NC and NA was 0.855,and NA and MA was 0.715,as well as MA and OA was 0.758.Conclusions:1.Plasma Fetuin-A and urinary Fetuin-A had a gradually increasing trend in different stages of renal lesions,which were higher than normal group,suggesting that Fetuin-A could be closely related to the occurrence and development of T2 DM.2.Plasma Fetuin-A and ACR were positively correlated.Urinary Fetuin-A had positively correlated with SBP,FPG,HbA1 c,urinary ?1-MG,urinary ?1-MG and creatinine ratio,ACR and plasma Fetuin-A,as well as negatively correlation with total protein,blood albumin.3.Duration,HbA1 c,urinary ?1-MG and creatinine ratio,urinary Fetuin-A were the independent influencing factor of In(ACR).4.Increased levels of urinary Fetuin-A may be associated with earlier renal tubular lesions in patients with T2 DM,as a reference for early screening of diabetic nephropathy.