| Background and ObjectiveDiabetes patients is significantly higher than the risk of cardiovascular events and death in diabetic patients,and about 40%of patients with diabetic kidney diseases in patients with diabetes,diabetic kidney diseases(DKD)is the leading cause of premature death in cardiovascular diseases(cardiovascular diseases CVD).Atherosclerosis is the basic pathological process of the occurrence of cardiovascular diseases,and atherosclerosis is considered as the pathological basis of macrovascular diseases.The occurrence and development of atherosclerosis include lipid infiltration,endometrial injury,inflammatory reaction,oxidative stress,activation of vascular smooth muscle cells(VSMC),platelet activation,thrombosis and so on.Cystatin C reflects an important marker of renal function,is not affected by age,activity,muscle mass and other factors,and cystatin C can predict cardiovascular events,and is not affected by kidney damage and other traditional risk factors.In this paper,a retrospective analysis of 308 cases of stage I to IV clinical data of patients with type 2diabetes mellitus and diabetic kidney diseases,on patients with stage I to IV diabetic kidney diseases urinary inhibition C(Cystain C)serum levels,carotid intima-media thickness,carotid intima-media thickness CIMT),the relationship between the analysis of other risk factors for carotid atherosclerosis,the comprehensive assessment for diabetic kidney diseases patients with cardiovascular disease,provide predictors and intervention measures.Materials and Methods1 MaterialsPatients with stage ?-? type 2 diabetic kidney diseases who were hospitalized in the second affiliated hospital of zhengzhou university from June 2014 to February2019 were selected as the study subjects,and the color doppler ultrasound diagnostic instrument(PHILIPS IE22)with probe frequency of 7 was adopted.0 MHz)carotid artery examination was performed to detect carotid intima-media thickness,carotid plaque number and plaque thickness.According to IMT,308 patients with stage ?-? diabetic kidney diseases were randomly divided into the normal group:108 patients with CIMT<1.0mm;In the thickening group,CIMT was 1.0mm,and there were 200cases with or without plaque formation in the carotid artery.General clinical data including gender,age,diabetes course,body weight,BMI,systolic blood pressure and diastolic blood pressure were collected from the normal group and the thickening group.Also collect fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1C),serum creatinine,blood uric acid,blood urea,the elf inhibition C,total cholesterol(total cholesterol TC),triglycerides,triglyceride(TG),high-density lipoprotein cholesterol(hdl-c),high density lipoprotein(HDL),Low density lipoprotein(Low density lipoprotein LDL)and other biochemical indicators,based on the neck artery intima-middle thickness and plaque volume plaque score,Endogenous creatinine clearance(Ccr)is calculated by Cockcroft-Gault formula.The diagnosis of type 2diabetes was in line with the diagnostic criteria for diabetes established by WHO in1999,and the diagnosis of diabetic kidney diseases was in line with the clinical practice guidelines for CKD evaluation and management issued by KDIGO in 2012.Exclusion criteria:(1)other types of diabetes;(2)patients with other renal diseases(such as IgA kidney diseases,membranous kidney diseases,etc.);(2)patients with a large number of hematuria or macroscopic hematuria,a large number of proteinuria or nephrotic syndrome in a short period of time,rapid decrease of GFR,accompanied by other systemic diseases or hypotension and other clinical manifestations inconsistent with diabetes;(3)patients with severe arrhythmia,prolonged QT,acute myocardial infarction,cardiac function level III or above,and old myocardial infarction;(4)patients with acute cerebral hemorrhage and cerebral infarction;(5)patients with lower limb artery occlusion,aortic stenosis and other macrovascular diseases.2 Statistic AnalysisSpss20.0 statistical software was used.The quantitative data in line with normal distribution were expressed as mean standard deviation(s),and the measurement data in non-normal distribution were expressed as median.Independent sample t test was used for the comparison of quantitative data conforming to normal distribution and variance homogeneity,non-parametric test was used for the comparison of measurement data not conforming to normal distribution,and chi-square test was used for qualitative data.The confounding factors were corrected by binary logistic regression analysis.The lowest quartile array(group A)0.79umol/l,the second quartile array(group B)0.79~1.25umol/l,the third quartile array(group C)1.25~1.5925umol/l,and the highest quartile array(group D)>1.5925umol/l.Test level=0.05,P<0.05 was considered statistically significant.Group A and group B,C,D group two comparison,inspection level?~/=0.05/6,P<0.0083,the difference was statistically significant;To compare the effects of various risk factors on the atherosclerotic plaque score in the neck,a multivariate linear retrospective analysis was performed.Results1 Independent sample t test showed that there were differences in cystatin C,age,diabetes course,diastolic blood pressure,fasting blood glucose,blood urea,total24h urine protein and Ccr level between the thickening group and the normal group in patients with stage i-iv diabetic nephropathy(P<0.05).2 Binary logistic regression was used to analyze cystatin C,age,diabetes course,diastolic blood pressure,fasting blood glucose,blood urea,24h total urine protein,Ccr and other influencing factors.After correction,it was found that cystatin C,age and blood urea were still independent risk factors for intimal thickening and plaque formation of carotid artery.3 The incidence of carotid intimal thickening with different cystatin C levels was different(P<0.05).Pairwise comparison of each group showed statistically significant differences between groups A and B,A and C,A and D,B and C,and B and D(P<0.0083),and the ratio of carotid intimal thickening increased with the increase of cystatin C level.However,when compared with group D,the difference was not statistically significant(P>0.0083),that is,when cystatin C level was>1.5925umol/l,the incidence of carotid intimal thickening did not increase.4 Use multivariate linear regression analysis,analysis(C,suppression,age,duration of diabetes,BMI,HbA1C,FPG,total cholesterol,low-density lipoprotein cholesterol,the influence of such indicators of carotid artery plaque integral tip(inhibition C,age,uric acid,urea,creatinine,and the effect of carotid artery plaque score was statistically significant(P<0.05),from the standard partial regression coefficient,the elf inhibition C had the greatest influence of carotid artery plaque integral;However,the course of diabetes,systolic blood pressure,diastolic blood pressure,fasting blood glucose,total cholesterol,and low-density lipoprotein had no statistical significance on the carotid plaque score(P>0.05).Conclusions1 In patients with stage ?-? diabetic kidney diseases,serum cystatin C is an independent risk factor for increased carotid intimal media thickness and plaque formation.2 In patients with stage ?-? diabetic kidney diseases,age,duration of diabetes,diastolic blood pressure,and fasting glucose Ccr are the influencing factors of atherosclerosis. |
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