The Predictive Value And Correlation Of Blood Cell Parameters And Retinol Binding Protein In Early Diabetic Kidney Disease

1.Background and ObjectiveDiabetic kidney disease(DKD),as a typical microvascular complication,has endangered more and more diabetic patient’s health.It often progresses gradually because of people’s inadequate attention and improper treatment,and eventually causes irreversible renal damage,greatly reducing life and quality of life.At present,24-hour urinary albumin excretion rate UAER and urinary albumin creatine UACR can greatly improve the screening efficiency of early diabetic kidney,but 20%-30%of diabetic nephropathy patients with disease progression are still missed.Moreover,the operation of 24-hour urine protein retention is complicated and the patients’compliance is inconsistent,which makes the early screening more difficult to cover all patients.Therefore,it is important to find more convenient and fast screening indicators for early diagnosis,early education,early intervention and effective prevention and control.In addition to genetic factors,metabolic disorders,oxidative stress,cytokines and other factors,hemodynamics are also closely related to the pathogenesis of diabetic nephropathy.Neutrophil-lymphocyte ratio NLR、platelet-lymphocyte ratio PLR as the hot inflammatory markers in recent studies,have been confirmed to be associated with acute myocardial infarction,post PCI reperfusion disorders,tumor prognosis,rheumatic disease activity and inflammatory state of end-stage dialysis patients.Retinol binding protein RBP is the medium to help vitamin a transport to the target cell to play its function.After binding with the membrane receptor of the target cell,it will break away.After glomerular filtration,reabsorption and catabolism of renal tubules,RBP has been a marker of renal function in the past.At present,it is found that RBP is a adiposecretory factor,which is closely related to the occurrence of metabolic syndrome.This paper reviewed the clinical data of 201 patients with type 2 diabetes mellitus and 65 healthy people,and discussed the relationship between blood cell parameters and retinol binding protein and early kidney disease,in order to find a faster early screening method.2.Objects and methods2.1 201 patients with type 2 diabetes who were treated in the Second Affi liated Hospital of Zhengzhou University from March 2018 to July 2019 were selected as the research objects.The diagnostic criteria were in line with the Chinese guidelines for the prevention and treatment of type 2 diabetes(2017 version).In half a year,three times of randomly cleaning mid morning urine were taken for UACR detection.According to the expert consensus on prevention and treatment of diabetic nephropathy(2014 Edition),the diagnostic criteria for diabetic nephropathy were recommended to be divided into simple diabetes group A and early diabetes kidney disease group B,65 healthy persons in our hospital at the same time were selected as control group C,and UACR was within the normal range.Exclusion criteria:Type 1 and special diabetes,gestational diabetes,acute hyperglycemia disorder;acute and chronic liver injury,hypertension,glomerulonephritis,massive albuminuria,end-stage renal disease,urolithiasis,post PCI,acute cerebrovascular disease,acute and chronic cardiac insufficiency,atrial fibrillation and other arrhythmias,acute and chronic infectious diseases,autoimmune diseases,thyroid disease and malignant tumors;large hands in the near future Patients with anemia(hemoglobin:male<120g/L,female.<110g/L)and other blood system diseases,who recently took hormones,antiplatelet aggregation drugs and other drugs to change the blood flow.2.2 methods:the sex,age,duration of diabetes,height and weight of the subjects were recorded,and body mass index(BMI＝weight/height 2)was calculated.Venous blood was drawn from patients with fasting for more than 8 hours.White blood cells,neutrophils,lymphocytes,red blood cell distribution width,platelets,triglyceride,total cholesterol,high density lipoprotein,low density lipoprotein,urea,creatinine,retinol binding protein,fasting blood glucose,glycosylated hemoglobin,urine routine and creatinine were recorded.Three times of clean morning urine were randomly collected within half a year to detect the UACR ratio.2.3 statistical methods:SPSS 21.0 statistical software was used for statistical analysis.The measurement data was expressed as mean±standard deviation(x±s).The comparison between the two groups was performed by independent sample t-test,the one-way ANOVA was used for those with homogeneous variance among the three groups,LSD was used to compare the differences between the two groups,nonparametric test was used to test the differences,Kruskal Wallis test was used to test the differences between the two groups.The correlation between UACR and blood cell parameters and RBP in risk factors is analysed by Pearson.The prediction value of research indicators on early diabetic kidney disease by ROC curve.(P<0.05).3.Results3.1 There was no significant difference in BMI、DBP、SBP and age among the three groups(P>0.05),but the course of diabetes in group B was significantly longer than that in group A(P<0.05).3.2 There was no significant difference in blood lipid and urea nitrogen among the three groups(P>0.05),but there were significant differences in fasting blood glucose,glycosylated hemoglobin,retinol binding protein and creatinine(P<0.05).The blood glucose of group A and group B was higher than that of group C(P<0.05),but there was no difference between group A and group B(P>0.05);the glycosylated hemoglobin level of group A and group B was higher than that of group C,and group B was also higher than that of group A P<0.05);the retinol binding protein of group B was significantly higher than that of group C and group A(P<0.05);the creatinine of group A and group B was significantly higher than that of group C(P<0.05)3.3 There were significant differences in WBC、NC、NLR、CV and PLR among the three groups(P<0.05).WBC of group A and B was higher than that of group C and group B(P<0.05);NC、NLR and PLR of group B were higher than that of group A and group C(P<0.05);CV of group B and group A were higher than that of group C(P<0.05).3.4 Binary logistic regression analysis showed that WBC、NLR、PLR、RBP glycosylated hemoglobin and the course of diabetes were risk factors of diabetic nephropathy.3.5 Pearson correlation analysis showed that NLR、PLR、WBC in blood cell parameters and RBP in serum were positively correlated with UACR.3.6 ROC curve showed that NLR and RBP were more sensitive to the prediction of early diabetic kidney disease than PLR,and the specificity of NLR and RBP was stronger than using both separately.4.Conclusions4.1 NLR、PLR、RBP、WBC、HbA1c and the course of diabetes are all risk factors of diabetic nephropathy.NLR、PLR、WBC in blood cell parameters and RBP in serum are positively correlated with UACR.4.2 The prediction of early diabetic kidney disease by NLR and RBP is more specific.