| ObjectiveThis paper mainly analyzed the changes of serum cystatin C(Cys-C),retinol binding protein(RBP)and neutrophil gelatinase associated lipocalin(NGAL)levels in different stages of type 2 diabetes melitus(T2DM).The correlation between serum Cys-C,RBP,NGAL levels and the developments of diabetic kidney disease(DKD)was studied.Furthermore,the application value of the combined detection of serum Cys-C,RBP,NGAL three indecators in the early diagnosis of DKD was further evaluated to provide direction and guidance for early detection of DKD and intervention measures.MethodsA total of 195 patient with T2 DM who were admitted to Shaanxi Provincial People’s Hospital from november 2018 to december 2019 were selected.All the selected T2 DM patients met the diagnostic criteria for diabetes set by the world health organization in 1999.According to UACR,T2 DM patients were divided into three groups:(1)single DM group with a total of 65 cases(UACR<30mg/g)was group A.(2)the early DKD group with a total of 63 cases(30mg/g≤UACR<300mg/g)was group B.(3)the clinical DKD group(UACR≥300mg/g)with a total of 67 cases was group C.Record the gender,age,duration of diabetes,systolic blood pressure(SBP),diastolic blood pressure(DBP),height,weight,body mass index(BMI)of all subject,and test fasting blood glucose(FBG),glycated hemoglobin Alc(HbAlc),triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),urea nitrogen(BUN),serum creatinine(Scr),Cys-C,RBP,NGAL,UACR.Statistical analysis of all the data was carried out by spss 25.0 software.Experimental design:(1)Comparative analysis of the basic data and routine test indicators of the subjects;(2)Serum levels of Cys-C,RBP,NGAL were compared between the three groups of T2 DM patients and the control group;(3)Spearman correlation analysis was used to explore the correlation between serum levels of Cys-C,RBP,NGAL and various clinical indicators in three groups of T2 DM patients;(4)The ROC curve was used to evaluate the value of single and in combined detection of serum Cys-C,RBP,NGAL in the early diagnosis of DKD.Results1.There was no statistically significant difference of the four groups in gender,age,SBP,DBP,and BMI(P>0.05).FBG and HbAlc in group A were higher than the control group,and the difference was statistically significant(P<0.05).FBG,HbAlc,TG and UACR in group B were higher than those in control group and group A,and the difference was statistically significant(P<0.05).FBG,HbAlc,TC,TG,UACR,Scr,BUN in group C were higher than those in group A and group B,and the difference was statistically significant(P < 0.05).There was no significant difference in UACR between the control group and group A(P>0.05).There was no significant different in the levels of Scr and BUN between the control group,group A and group B(P>0.05).2.Serum levels of Cys-C and NGAL in group A were higher than those in control group,and the difference was statistically significant(P<0.05).Serum levels of Cys-C,RBP,NGAL in group B were higher than those in control group and group A,and the difference was statistically significant(P<0.05).Serum levels of Cys-C,RBP,NGAL in group C were higher than those in control group,group A and B,and the difference was statistically significant(P <0.05).There was no significant difference in RBP between the control group and group A(P>0.05).3.In the three groups of T2 DM patients,spearman correlation analysis shows that serum Cys-C,RBP,and NGAL were positively correlated with Scr,BUN,and UACR(P<0.05),and negatively correlated with eGFR(P<0.05).4.The ROC curve analysis of serum Cys-C,RBP,and NGAL in predicting early DKD shows that the area under the curve of serum Cys-C in diagnosing early DKD was 0.785(P<0.05),the optimal cut-off value was 0.910mg/L,the sensitivity was 88.9%,and the specificity was 70.8%.The area under the curve of serum RBP was 0.751(P<0.05),the optimal cut-off value was 53.88mg/L,the sensitivity was 71.4%,and the specificity was 80%.The area under the curve of serum NGAL was 0.827(P<0.05),the optimal cut-off value was 67.30ng/ml,the sensitivity was 87.3%,and the specificity was 72.3%.When Cys-C、RBP and NGAL were combined,the area under the curve of Cys-C combined with RBP was 0.830(P<0.05),the sensitivity was 81.0%,and the specificity was 75.4%.The area under the curve of Cys-C combined with NGAL was 0.860(P<0.05),the sensitivity was 90.5%,and the specificity was 72.8%.The area under the curve of RBP combined with NGAL was 0.857(P<0.05),the sensitivity was 88.9%,and the specificity was 81.2%.The combined detection of serum Cys-C,RBP and NGAL had the largest area under the curve(AUC=0.876),the sensitivity and the specificity was 92.7% and 83.6%,respectively.Conclusion1.In the early kidney injury of T2 DM patient,the changes of serum Cys-C,RBP,and NGAL are superior to the changes of Scr and BUN,and can be used as the sensitive biomarkers for early DKD.2.When serum Cys-C,RBP and NGAL were detected separately,the diagnostic efficiency of serum NGAL for early DKD was better than that of Cys-C and RBP.The combined detection of the three indexes improves the diagnostic accuracy of early DKD.3.To some extent,the changes of serum Cys-C,RBP and NGAL can reflect the severity of renal injury in T2 DM patients. |
