Analyzing Cystatin C And Risk Factors In Different Urinary Protein Staging In Middle-aged And Elderly Patients With Type 2 Diabetic Kidney Disease

Objective: To investigate the correlation between cystatin C and risk factors in different urine protein stages of middle-aged and elderly patients with diabetic kidney disease.Methods: A total of 172 patients with type 2 diabetes who were hospitalized in the Department of Geriatric Endocrinology and Endocrinology,the First Affiliated Hospital of Guangxi Medical University from January 2016 to February 2019 were enrolled.According to the 2017 China Guidelines for the Prevention and Treatment of Type 2 Diabetes and the Global Prognosis for Kidney Disease Improvement(KDIGO)Guidelines,all subjects were grouped with UACR as a criterion for diabetic kidney disease(DKD):69 patients in the diabetes alone,There were 63 patients in the microalbuminuria group,and 40 patients in the large proteinuria group,and the CKD staging were all in G3 a stage or above.The following indicators were collected for each group of subjects: 1.General information of subjects,such as gender,age,duration ofdiagnosis of diabetes,weight,height,BMI,history of hypertension,history of smoking,history of drinking,past history,etc.;2.laboratory indicators:determination of fasting blood glucose(FBG),2 hours postprandial blood glucose(2h-PG),fasting C peptide(F-CP),postprandial 2 Hour C peptide(2h-CP),fasting insulin(INS),postprandial 2hours insulin(2h-INS),total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL),low density lipid Protein(LDL),homocysteine(HCY),25-hydroxyvitamin D3(25(OH)D3),parathyroid hormone(PTH),alkaline phosphatase(ALP),serum calcium(Ca),blood phosphorus(P),Urea nitrogen(UREA),serum creatinine(Scr),cystatin C(Cys-c),blood uric acid(SUA),glycosylated hemoglobin(HbA1C),24-hour urine microalbumin(24U-MALB),random urine microalbuminuria/urinary creatinine(UACR),albumin(ALB),retinol binding protein(RBP-4),and HOMA-IR,HOMA-β values and recordswere calculated for all subjects by formula,and the above indicators werestatistically analyzed.Results: The levels of HCY,UREA,Scr,Cys-C,SUA,HbA1 C,24U-MALB and UACR increased in the three groups.HCY,HbA1 C,24U-MALB and UACR in the microalbuminuria group were higher than those in the simple diabetes group(P<0.05).HCY,Scr,Cys-C,SUA,and UACR in the large proteinuria group were higher than those in the microalbuminuria group(P<0.05);Scr,Cys-C,HbA1 C,and UACR were higher in the large proteinuria group than in the simple diabetes group(P<0.05).2h-CP,INS,2h-INS,HOMA-β,25(OH)D3,and EPI-eGFR were decreased in the three groups.In the microalbuminuria group,2h-CP and HOMA-β were lower than the simple diabetes group.P<0.05);HOMA-β,25(OH)D3,EPI-eGFR were lower in the large proteinuria group than in the microalbuminuria group(P<0.05);2h-CP,25(OH)D3 in the large proteinuria group and EPI-eGFR werelower than those in the simple diabetes group(P<0.05).At the same time,LDL and HOMA-IR in the microalbuminuria group were higher than those in the simple diabetes group(P<0.05).RBP-4 and HOMA-IR in the large proteinuria group were higher than those in the microalbumin group(P<0.05).Spearman correlation analysis showed that Cys-C was positively correlated with DM duration,HbA1 C,SUA,24U-MALB,UACR,Scr,HCY,and the correlation coefficients were 0.153、0.169、0.316、0.233、0.175、0.707、0.516(P<0.05),Cys-C and EPI-eGFR is negatively correlated with a correlation coefficient of0.179.According to the degree of urine protein,the three groups were graded as the dependent variable,with DM course,age,gender,history of hypertension,smoking history and drinking history,HbA1 C,SUA,HCY,HOMA-β,HOMA-IR,RBP-4,and LDL were used as independent variables.The regression regression method was used to screen out the history of hypertension,HbA1 C,SUA,and HCY as independent variables,The results showed that HbA1 C and SUA were risk factors for DKD proteinuria.Conclusion:1.As the degree of urinary protein gradually increased,Cys-C increased gradually,and eGFR gradually decreased,suggesting that both theymaybe consistent with the trend of severity of urinary protein in diabetic kidney disease;2.HbA1 C and SUA are risk factors for the gradual increase of DKD urine protein.