Preliminary Screening Of Metabolic Markers Related To Diabetic Nephropathy

Objectives:The aim of this study was to investigate the changes of metabolic biomarkers in the development of type 2 diabetes mellitus with chronic nephropathy.In order to provide a new idea and diagnostic index for early diagnosis,effective prevention and control of diabetic nephropathy,metabolic potential markers which can effectively reflect the changes of early nephropathy in patients with type 2 diabetes mellitus and can be diagnosed in the early stage of diabetic nephropathy are found out to be the potential biomarkers of metabonomics.Methods:From September 2017 to October 2019,the patients with type 2 diabetes mellitus and type 2 diabetes mellitus complicated with diabetic nephropathy were collected from the Department of Endocrinology and Metabolism of the first Hospital of Jilin University.The sex,age and history of diabetes mellitus were analyzed retrospectively.Urine protein and other general data and the patient's blood samples Metabonomics test indicators.SPSS18.0 was used for statistical analysis.Results:1?General information :(1)Among 127 patients with type 2 diabetes mellitus,45 patients with diabetes mellitus without diabetic nephropathy(Non-DKD),46 patients with diabetes mellitus complicated with microalbuminuria(Micro-DKD)and 36 patients with diabetes mellitus complicated with massive albuminuria(Marco-DKD).(2)There were differences in high CRP,low density lipoprotein and cholesterol,glomerular filtration rate,creatine,cystine C,Retinol binding protein and 24-hour urinary protein among the three groups of Non-DKD,Micro-DKD,Marco-DKD.There were differences in 24-hour urinary microalbumin,? 1 microglobulin,KAP light chain,LAM light chain and Retinopathy.The above indexes in Marco-DKD group were significantly higher than those in Non-DKD and Micro-DKD group.2?Metabonomics test:(1)Cit,Cys,Gly,His,Leu,Met,Orn,Pip,Pro,Thr,Trp,Val,C0?C4-OH? C5 DC,?C14: 1?C24,?C10:2 ?C18:2 were found in blood samples of the three groups of patients.There was significant difference in among the three groups(P < 0.05).There was a good correlation abouturinary microalbumin except C5 DC,which could be used as a reference index for potential early clinical diagnosis.(2)The results of univariate logistic regression analysis suggested that Cit,Leu,Thr,Trp,Val,C0,C4-OH was independently correlated with Micro-DKD,and its increase was related to the occurrence of Micro-DKD.(3)ROC curve suggested that the above seven metabolites were valuable for the diagnosis of Micro-DKD,The maximum area under Val curve(AUC=0.689)was 17.8%,the specificity was 82%,and the cut-off value was more than 147.46 umol / L.Leu curve(AUC=0.674),the sensitivity was 50%,the specificity was 80%,and the cut-off value was more than 136.82umol/L.The diagnostic value of Cit combined with Val was 56.5% and the specificity was 86.2%.Conclusions:(1)With the development of diabetic nephropathy,high sensitive C-reactive protein,low density lipoprotein,cholesterol,cystine C,Retinol binding protein,24-hour urine protein,There were differences in 24-hour urinary microalbumin,? 1 microglobulin,KAP light chain and LAM light chain.The patients in Marco-DKD group were significantly higher than those in Non-DKD group and Micro-DKD group,and the patients in Micro-DKD group were higher than those in Non-DKD group.(2)There was a good correlation between Cit,Leu,Thr,Trp,Val,C0,C4-OH and 24-hour urinary microalbumin in Non-DKD,Micro-DKD,Marco-DKD group,and it was independently correlated with Micro-DKD.(3)The above seven metabolites were valuable in the diagnosis of diabetic nephropathy,The maximum area under Val curve(AUC=0.689)was 17.8%,the specificity was 82%,and the cut-off value was more than 147.46 umol /L.Leu curve(AUC=0.674),the sensitivity was 50%,the specificity was 80%,and the cut-off value was more than 136.82umol/L.The diagnostic value of Cit combined with Val was 56.5% and the specificity was 86.2%.