Research On Correlation Between Lipoprotein-associated Phospholipase A2 And Diabetic Kidney Disease

ObjectiveDiabetic kidney disease(DKD)is one of the microvascular complications of diabetes.It is one of the main causes of death in diabetic patients.Lipoprotein-associated phospholipase A2(Lp-PLA2)is a novel inflammatory marker,which is a risk factor and predictor of atherosclerotic events.Recently,some scholars have found that Lp-PLA2 is elevated in patients with diabetic retinopathy(DR),suggesting that Lp-PLA2 is significantly associated with DR.Both DR and DKD are diabetic microvascular complications and have a similar pathological basis.Therefore,we speculate that Lp-PLA2 may be involved in the development of DKD.At present,there are few studies on the correlation between Lp-PLA2 and DKD,this study aims to determine the association between Lp-PLA2 and incidence of DKD in patients with type 2 diabetes mellitus(T2DM).MethodsA total of 1452 patients were enrolled in this study,including 585 patients with DKD.The following data were collected: general information,glycated hemoglobin(HbA1c),fasting and 2 hours post-meal serum C-peptide,high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triglyceride(TG),24 hours urine albumin excretion rate(UAER),blood creatine,blood albumin,uric acid and Lp-PLA2.The relationship between Lp-PLA2 and diabetic complication was analyzed by logistic regression.The risk factors of DKD were analyzed by Pearson or Spearman correlation analysis.Results1.Of the 1452 patients with T2 DM,40.3% were diagnosed with DKD and the correlation between DKD and Lp-PLA2 was the most significant one compared to other diabetic complications(odds ratio = 1.651,P < 0.001).2.Plasma Lp-PLA2 level in patients with DKD was significantly higher and increased Lp-PLA2 level was independently associated with the incidence of DKD after adjustment for age,gender,duration of diabetes,HbA1 c,body mass index and blood lipids,blood pressure,presence of coronary heart disease and carotid plaque,and use of statins(odds ratio = 1.545,P = 0.013).3.Lp-PLA2 was found to be positively correlated with UAER(r = 0.123,P < 0.001),and negatively correlated with estimated glomerular filtration rate(eGFR)(r =-0.71,P = 0.009).4.The correlations between eGFR and Lp-PLA2 were more significantly in older patients(? 60 years)or patients with longer duration of diabetes(? 10 years)(P < 0.01).The correlations between UAER and Lp-PLA2 were all significantly in the patients with different ages and durations of diabetes(P < 0.01).5.Plasma Lp-PLA2 level was negatively correlated with HDL-C in patients with T2DM(r =-0.094,P = 0.001),and positively correlated with systolic blood pressure,diastolic blood pressure,body mass index,fasting blood glucose,HbA1 c,C-P0,homeostasis model assessment of C-peptide secretion(HOMA-CR),TC,TG,LDL-C(P < 0.05).After controlling body mass index,systolic blood pressure,and diastolic blood pressure,plasma Lp-PLA2 level was positively correlated with HbA1 c,C-P0,and HOMA-CR,homeostasis model assessment for pancreatic ? cell function(HOMA-?),TC,TG,LDL-C(P < 0.05).Conclusions1.The high level of Lp-PLA2 is positively correlated with DKD.2.The high level of Lp-PLA2 is a risk factor for DKD.3.Increased plasma level of Lp-PLA2 is associated with incidence and development of DKD in patients with T2 DM.Detection of Lp-PLA2 level could be helpful in early diagnosis and prevention of DKD.