Expression Of Serum Cyclophilin A In Patients With Diabetes Nephropathy And Its Clinical Significance

Background.Diabetic nephropathy(DN)is a common and severe microvascular complication of diabetes mellitus(DM)and is also a major cause of death in diabetic patients.With the incidence of diabetes increased in China,DN has become the second largest cause of end stage renal disease(ESRD)while in Europe and the United States is the first reason.The exact pathogenesis of DN is not yet fully defined and it is now widely believed that it is associated with hyperglycemic-mediated polyol pathway activation,advanced glycosylation of terminal product formation,protein kinase C pathway activation and renal hemodynamic changes.Oxidative stress inflammation is the common mechanism of the pathways mentioned above.In recent years more and more studies have found that DN caused by glucose metabolism disorders,and renal hemodynamic changes etc.,mediated by the chronic development of inflammation and a series of renal glomerular capillary changes.Inflammatory factors that occur during this inflammatory response are a key factor in inflammatory injury,so understanding the inflammatory factors associated with DN progression will prevent and treat DN.Cytokinin A(CyPA)is an oxidative stress-induced secretion factor which has chemotactic and activating effects on many inflammatory cells.At present,the high expression of CyPA has been detected in various inflammatory diseases such as atherosclerosis,sepsis,rheumatoid arthritis and inflammatory heart disease,which is positively correlated with the severity and activity of the disease.Kidney immunohistochemistry(TMA-IHC)showed that CypA increased in the proximal tubule epithelium of the kidney compared with other tissues and it was also associated with CsA's renal toxicity.Therefore cyclophilin A may be involved in the inflammatory reaction of diabetic nephropathy and correlated with the occurrence and development of DN.Objectives.Observing the changes of serum lever cyclophilin A in patients with Diabetes Nephropathy and Its Clinical Significance-Methods.From October 2014 to June 2015,we enrolled 86 patients with Diabetes Nephropathy who received treatment in endocrine department of the Second People's Hospital of Lianyungang.At the same time,we enrolled 26 healthy individuals who received physical examination in the hospital as conttols(group A).According to the level of urinal albumin excretion rate(UAER),86 patients with Diabetes Nephropathy were divided into three groups:nomal albuminuria group(group B,n=30)(UAER<30mg/24h),male 12,female 18,the mean age was 50.6±1.88 years;microalbuminuria group(group C,n=28)(UAER30-300mg/24h),male 16,female 12,the mean age was 49.7±1.59 years;and macroalbuminuria group(group D,n=28)(UAER>300mg/24h),male 15,female 13,the mean age was 54.2±1.42 years.General clinical information were collected.Serum cyclophilin A was measured using enzyme-linked immunosorbent assay(ELISA).Moreover,plasma glucose?lipid?blood pressure?HbA1c?blood urea nitrogen(BUN)?creatinine,(Scr)?cystatin C was calculated.Compare the parameters Between groups,,further correlation analysis were carried on.Select the microalbuminuria group(group C)(UAER30-300mg/24h)as the experimental group in the conventional control of blood glucose,blood pressure and blood lipid on the basis for the application of small dose of Tripterygium wilfordii around,to observe the relationship between the CyPA level and the level of urine protein.Results.1.There was significant difference in age between group.A and group D(P<0.05),and there was no statistical difference between case group and control group in other general situations,(P>0.05)2.(1)The levels of serum CyPA,UAER,glucose,lipids and glycosylated hemoglobin of both other groups(B,C,D)were significantly higher than those of group A(P<0.05).(2)The levels of serum CyPA and UAER of group C and group D were significantly higher than those of group B(P<0.05).(3)There was no significant difference in serum Cr and BUN levels between the four groups.(P>0.05).3.The serum CyPA levels treated with tripterygium wilfordii polyglycoside was significantly lower than pre-therapy(P<0.05);The 24-hour urine protein levels treated with Tripterygium wilfordii polyglycoside was also significantly lower than pre-therapy(P<0.05).The CyPA levels were positively correlated with urinary protein levels.Conclusion.Increased level of Serum level cyclophilin A is correlated with the morbidity of diabetic nephropathy.Cyclophilin A may play an inportant role in prediction of diabetic nephropathy and become an important target for the prevention and treatment of diabetic nephropathy in the future.