Clinical Significance Of Skin Ages Detection In Diabetic Kidney Disease

Objective In this study,the skin AGEs were detected by fluorescence spectroscopy in diabetic patients,serum AGEs were detected by ELISA,and the value of skin AGEs in early diagnosis of diabetic nephropathy was investigated.The relationship between skin AGEs level and renal function progression was studied in patients with clinically diagnosed diabetic nephropathy.To explore new sensitive and non-invasive methods for predicting the progression of renal damage in diabetic nephropathy.Study subjects and methods1.Study subjects:The study subjects were 173 patients admitted to the Department of Nephrology and Endocrinology of the First Affiliated Hospital of Anhui Medical University from January 2017 to January 2018.Among them,patients with diabetesmet the 1999 WHO diagnostic criteria for diabetes.According to the diagnostic criteria for diabetic nephropathy and the glomerular filtration rate published in 2014,diabetic patients were divided into three groups,namely,DM group(diabetes alone)and DKD1 group(Diabetic nephropathy,eGFR?45 m L/min/1.73 m2),DKD2 group(diabetic nephropathy,eGFR<45 m L/min/1.73 m2).In the control group(NC group),51 cases were normal renal function,non-diabetes,and age matched for renal puncture in the Department of Nephrology.2.Research methods:(1)Collect general information of the patient(such as name,gender,age,duration of diabetes,height,weight,body mass index,systolic blood pressure,diastolic blood pressure,etc.),On the next morning,the patient took blood on an empty stomach in the morning,and took random urine and 24-hour urine to the laboratory of our hospital to test various laboratory indicators(such as glycosylated hemoglobin,hemoglobin,triglycerides,total cholesterol,total protein,albumin,serum creatinine,blood uric acid,high-sensitivity C-reactive protein,microalbuminuria,24-hour urine protein quantification),the patient underwent fundus examination in our hospital on the second day after admission;(2)All subjects were examined in the endocrinology department of our hospital on the afternoon of the next day for the detection of skin AGEs;(3)All the subjects were sampled fasting blood in the morning after admission and stored regularly.Serum AGEs were detected by double antibody sandwich enzyme-linked immunosorbent assay.3.Results:(1)There was no significant difference in age,gender,BMI,DBP,TP and UA between the diabetic group and the control group(P>0.05).The skin AGEs,SBP,Scr,TG and TC in the diabetic group were higher than the control group;serum AGEs,Alb Below the control group,the difference was statistically significant.(2)Pearson correlation analysis between skin AGEs and serum AGEs in 173 subj ects showed that skin AGEs were negatively correlated with serum AGEs,P<0.05,and the difference was statistically significant.(3)According to the stage of chronic kidney disease,the components of diabetic nephropathy were DKD1 group(eGFR?45 m L/min/1.73m2)and DKD2 group(eGFR<45 mL/min/1.73m2),and compared with DM group in simple diabetes group.DKD2 group skin AGEs were higher than DKD1 group,DKD1 group skin AGEs was higher than DM group,the difference was statistically significant(P<0.05).There was no significant difference in serum AGEs among the three groups(P>0.05).(4)Pearson correlation analysis between skin AGEs and microalbuminuria in patients with diabetes showed that there was a significant positive correlation between skin AGEs levels and urinary microalbumin levels in diabetic patients(r = 0.484,P<0.01).(5)Risk factors of skin AGEs: Spearman correlation analysis showed that skin AGEs were positively correlated with age,Scr,and diabetic retinopathy(rvalues were 0.503,0.514,and 0.455,respectively),and negatively correlated with DBP,HbA1c,Alb,and Hb(r values were-0.215,-0.217,-0.305,-0.477).Multivariate linear regression analysis showed that age and Scr level were independent factors for skin AGEs.(6)Multivariate logistic regression analysis showed that skin AGEs(0R=1.113,P<0.01)were risk factors associated with diabetic nephropathy.(7)In diabetic patients,the area under the curve(AUC)for detecting diabeticne phropathy by skin AGEs was 0.751 [95% CI(0.662,0.841)],and the optimal cut-point value of AGEs was 77.90,and the sensitivity was 68.75%.The specificity was 71.43%,the positive likelihood ratio was 2.41,and the negative likelihood ratio was 0.44.4.Conclusion:(1)Skin AGEs are more stable and reliable than serum AGEs.The use of fluor escence spectroscopy to detect skin AGEs has the advantages of non-invasive,economical and convenient,and is more easily accepted by patients.(2)Skin AGEs are positively correlated with microalbuminuria and diabetic retinopathy.Fluorescence spectrometry for detecting skin AGEs can be used for early screening of diabetic nephropathy.Combined monitoring of skin AGEs,urinary microalbumin and retinopathy may improve the diagnosis of early diabeticne phropathy.Reliability.(3)AGEs may be involved in the development of diabeticnephropathy,and the level of skin AGEs is positively correlated with the progression of diabeticnep hropathy.