Significance Of Peripheral Blood NLR And NGAL In Early Diagnosis Of Diabetic Kidney Disease

BackgroundDiabetes mellitus is one of the commonest chronic diseases in the world,which affects our daily life seriously.With the development of economy and the changes of people's life style,we get little exercise but more obesity.The prevalence of diabetes mellitus is increasing,especially type 2 diabetes mellitus(T2DM).Diabetic kidney disease(DKD)is the commonest cause of end stage renal disease(ESRD)in the world.It is the leading cause of death in diabetics.There are few clinical symptoms in the early stage of DKD.Once persistent proteinuria and impairment of kidney appeared,the diabetics will take a turn for the worse.Ultimately,it will develop into end-stage renal failure.If we can find it and take effective interventions as soon as possible,the development of DKD will be delayed.Early clinical diagnosis of DKD is particularly important.In recent years,there have been more and more researches on early diagnostic indicators of DKD.The specificity,sensitivity,feasibility,and cost of detection of these indicators are different.In this study,we investigated the significance of peripheral blood neutrophil lymphocyte ratio(NLR)and neutrophil gelatinase-associated lipocalin(NGAL)in the early diagnosis of DKD,which provides a clinical reference for the early clinical discovery of DKD.PurposeBy observing and analyzing the differences of NLR and NGAL in peripheral blood of healthy control group and T2 DM groups,the relationship between them and the development of DKD was compared,and they were compared with urinary albumin excretion rate(UAER),serum creatinine(Scr),fasting blood-glucose(FBG),triglyceride(TG),and total cholesterol(TC).The sensitivity and specificity of peripheral blood NLR and NGAL for early diagnosis of DKD will be further discussed.We hope that this study will provide practical evidence and reference value for early detection of diabetic kidney injury in clinical practice.Methods60 patients with clinical diagnosis of T2 DM from Huaihe Hospital of Henan University from November 2017 to September 2018 were selected,including 30 males and 30 females,aged 43-76 years old.The mean age is(56.25±9.03)years old.We should exclude infection,primary and other secondary kidney disease,kidney stones,renal artery stenosis,hepatitis,blood diseases,autoimmune diseases,malignant tumors,poisoning,recent special medication history,acute complications of diabetes and other factors.20 cases of healthy physical examination were selected in the same hospital over the same period as the normal control group,including 9 males and 11 females,aged 46-70 years old,with an average age of(54.00±7.02)years old.We should exclude diabetes mellitus,hypertension,nephritis,chronic infectious diseases,other metabolic diseases,cardiovascular and cerebrovascular diseases and acute infectious diseases.According to the Mogensen staging criteria,patients in the DM groups were divided into three groups according to the degree of UAER: Group A: normal albuminuria(UAER < 30 mg/24h),20 cases(11 males,9 females).The average age was(53.45 ± 7.59)years old.Group B: microalbuminuria group:(UAER 30-300mg/24h),20 cases,(10 males,10 females).The average age was(58.25±9.86)years old.Group C: clinical proteinuria group:(UAER> 300mg/24h),20 cases(9 males,11 females).The average age was(57.05±9.26)years old.Fasting venous blood samples of all subjects were collected.Then,the content of NGAL can be determined.The urine was left for 24 hours.The total amount was recorded.After shaking in a test tube,10 ml of urine was taken for microalbumin,and finally UAER was calculated.Strictly collect and record observational indicators of the control group and the diseased groups,such as gender,age,fasting blood glucose(FBG),triglyceride(TG),total cholesterol(TC),serum creatinine(Scr),absolute value of lymphocytes and neutrophils,and then calculate NLR.Results1.There was no significant difference in gender and age between the groups(p>0.05),which had a good homogenous basis.2.The levels of FBG and TG increased in the control group,A group,B group and C group.The difference between the groups was statistically significant(p<0.001).There was no significant difference in TC between the control group and the A group(P>0.05).There were significant differences in the TC between the other groups(p<0.001).3.The levels of Scr increased in the control group,A group,B group and C group.The C group was significantly higher than the control group,A group and B group,the difference was statistically significant(p<0.001);the control group and the A group(p=0.852)had no significant difference;between the control group and the B group(p= 0.060)The difference was not statistically significant;there was no significant difference between group A and group B(p=0.089).UAER increased in the control group,group A,group B,and group C in turn.There was no significant difference between group A and control group(p=0.934).There was significant difference between group B and control group(p=0.012).There was significant difference between group A and group B(p=0.015).There were significant differences between group C and control group,group A and group B(p<0.001).NGAL and NLR increased in the control group,A group,B group and C group,and the difference was statistically significant.The differences between the four groups were statistically significant(p < 0.001).4.There were positive correlations between NGAL and NLR and FBG,TG,TC,Scr and UAER(p<0.001),and no significant correlation with age and gender(p>0.05).5.The ROC curve shows that the AUC values of NGAL and NLR are higher than the AUC values of UAER,and the sensitivity and specificity of them are higher than that of UAER,suggesting that NGAL and NLR have higher diagnostic rates than UAER;The AUC value,sensitivity,and specificity of Scr have no statistical significance(P > 0.05).Conclusions1.Peripheral blood NLR and NGAL are more sensitive and reliable in the early diagnosis of DKD than UAER.Intervention measures such as protecting the kidney should be taken as early as possible when UAER and Scr are not elevated.2.Combined detection of peripheral blood NLR and NGAL has a higher diagnostic rate for DKD,providing a clinical reference for early detection of kidney damage caused by diabetes.