Correlation Between The Detection Of Serum Cystatin C Combined With Urinary Alpha 1 Microglobulin And Diabetic Nephropathy

Objective:Diabetes mellitus(DM)is one of the most important chronic non communicable diseases that threaten the global human health.The majority of patients with type 2diabetes(T2DM)can cause multiple system damage and cause chronic damage and dysfunction of various tissues,especially in the eyes,kidney,heart,blood vessels and nerves.Worldwide,its morbidity and associated health complications have caused heavy mental and financial burden to the state,family and individuals.Diabetic nephropathy(DN)is one of the serious chronic complications of diabetes.It is also the most common cause of chronic kidney disease worldwide,which eventually leads to end-stage renal disease(ESRD)as the main cause of the high mortality of diabetes.Related data statistics show that the incidence of DM and DN is increasing year by year.However,it is still challenging to identify diabetic renal complications by effective methods.At present,serum creatinine(Scr),urea nitrogen(BUN),creatinine clearance rate(Ccr)and urinary microalbumin(mAlb)are the detection indexes of diabetic renal impairment,but there are still various shortcomings.Therefore,it is an urgent need to find a more convenient,effective and sensitive method to evaluate the Glomerular filtration rate(GFR)function at an early stage.In recent years,it has been found that cystatin C(CysC)and alpha 1-microglobulin(?1-MG)are more advantageous than Scr,BUN,Ccr and mAlb in reflecting early renal disease in DN.Studies have shown that Cys C is an independent risk factor forearly DN and an ideal endogenous marker reflecting GFR changes.Only trace amounts of ?1-MG are discharged from the final urine,and the quality of ?1-MG in urine is stable.It is more valuable for the diagnosis of early DN.And ?1-MG is a very valuable diagnostic marker protein of renal tubule injury.The purpose of this study was to explore the correlation between the detection of Serum CysC and urinary?1-MG levels and DN in patients with T2 DM,and to provide new ideas for the early detection,evaluation,treatment and prognosis of DN.Methods:A total of 156 patients with type 2 diabetes from November 2016 to November2017 in the China-Japan Union Hospital of Jilin University were selected as the research subjects.Carefully collect the medical history,basic data collection and biochemical test results.The elimination of type 1 diabetes and other types of diabetes,stress state,urinary albumin positive caused by renal parenchymal lesions or urinary tract infection,diabetic ketoacidosis or hypertonic state,acute and chronic hepatitis or other acute and chronic inflammation or rheumatic disease,etc.According to the urinary albumin excretion rate(UAER),it was divided into simple diabetic mellitus group(SDM),early diabetic nephropathy group(EDN),and clinical diabetic nephropathy group(CDN).The serum Cys C,urine ?1-MG,Scr and BUN levels,positive rate and correlation analysis were compared between the 3 groups.Results:1.The comparison results of general data and blood and urine test of each group of diabetic nephropathy group are show that: There were significant differences in the course of disease,SBP,TC,HbA1 C,Cys C,?1-MG,Scr,BUN and mAlb between the three groups(P<0.05);There was no significant difference in age,BMI,DBP,TG,HDL-C and LDL-C between three groups(P>0.05).2.Compared with the renal function indexes of each group are show that: In group EDN and group CDN,the levels of CysC,?1-MG,Scr and BUN all increased,and the difference was statistically significant(P<0.05),moreover,the changes of Cys C and ?1-MG in the two groups were significantly different than those in Scr and BUN(P<0.05).With the aggravation of the disease,Cys C and ?1-MG gradually increased significantly,the difference was statistically significant(P<0.05).3.The positive results of different index in different groups showed that: With the increase of microalbuminuria,the positive rate of each index increased.In group SDM,the positive rate of Scr and BUN was relatively low,not more than 5%,in group EDN,the positive rate of Scr and BUN was not more than 25%,however,the positive rates of CysC and ?1-MG in SDM group were 12.5% and 37.5% respectively,especially with the increase of ?1-MG,in particular,the positive rate of combined detection with urinary CysC and ?1-MG can be increased to 40%,In group EDN,the positive rate was 90.74%,in group CDN,the positive rate of Cys C combined with alpha 1-MG was 100%,compared with the positive rate of CysC,Scr and BUN alone,the difference is statistically significant(P<0.05).In group EDN,the positive rate of all indicators from high to low was Cys C combined with ?1-MG>?1-MG>CysC>Scr>BUN.4.Correlation analysis in early diabetic nephropathy group: There was a significant and positive correlation between the serum CysC and the course of disease,SBP,TC,LDL,HbA1 C,Scr,BUN,?1-MG,mAlb,and had no correlation with sex,age,BMI,DBP,TG,HDL.There was a significant and positive correlation between the urinary ?1-MG and the course of disease,HbA1 C,Scr,BUN,CysC and mAlb,and had no significant correlation with sex,age,BMI,SBP,DBP,TC,TG,HDL,mAlb.There was a significant correlation between m Alb and SBP,TC,LDL,HbA1 C,Scr,BUN,Cys C,and ?1-MG,and had no significant correlation with sex,age,course of disease,DBP,BMI,TG,and HDL.After controlling for age,sex,course of disease,SBP,DBP,BMI,TC,TG,HDL-L,LDL-L,HbA1 C and other related factors,the partial correlation result of mAlb with each of clinical index show that: The correlation of m Alb with Cys C and ?1-MG is better than that of Scr and BUN,and both was positively correlated.It can be used as an indirect indicator of glomerular filtration rate,and then to evaluate the degree of renal dysfunction.Conclusion:1.Serum Cys C and Urinary ?1-MG are more sensitive,reliable and meaningful for early diagnosis of diabetic nephropathy than Scr and BUN.2.In the early stage of diabetic nephropathy,combined detection of serum Cys C and Urinary ?1-MG can increase the positive detection rate of diabetic kidney damage.3.The combined detection of serum Cys C and Urinary ?1-MG may be of guiding significance for early detection,assessment,follow-up treatment and prognosis of diabetic nephropathy.