Clinical Significance Of Determination Of Ho/co System In Patients With Diabetic Nephropathy

Objective: To explore the change of HO/CO system and relationships to NOS/NO system,SOD and MDA in patients with diabetic nephropathy and to investigate its clinical significance and provide an evidence of diabetic nephropathy.Methods:1. Sample collection: collect 127 type2-diabetic patients and divide into three groups according to levels of urinary Alb: nil nephropathy(DM, normoalbuminuria<20mg/l), 45 cases,26 males and 19 females; incipient nephropathy(DMⅠ, microalbuminuria 20-200mg/l), 42 cases, 24 males and 18 females; clinical nephropathy(DMⅡ, clinical albuminuria>200mg/l),40 cases, 17 males and 23 females. Normal people 30 cases. Collect serum sample, and record the basic informations.2. Index assay: assay FBG,HbA1c,TG,TC,HDL,LDL,bilirubin,UA,BUN,Cr,urinary Alb,SOD,MDA,NO,NOS,CO,serum Fe and so on.3. Statistical analysis: by using spss 11.5 software package, comparison of the groups was evaluated by one way variance analysis or nonparametric test. Correlation between two variances was analyzed by spearman's correlation analysis or pearson's correlation analysis. The significance level was set at P<0.05.Results:1. HO-CO system: Serum bilirubin in each group have descendant tendency, DMⅠgroup is lower than the normal control group(P<0.01or <0.05); DMⅡgroup is lower than DMⅠgroup(P<0.01or <0.05).serum Fe and CO in each group have descendant tendency, DMⅠgroup is lower than the normal control group(P<0.05); DMⅡgroup is lower than DMⅠgroup(P<0.05). CO is negatively correlated with BUN,Cr,urinary Alb and MDA(P<0.01or <0.05). There is a close correlation beteewn serum bilirubin and related factors of diabetic nephropathy. Serum Fe is negatively related to urinary Alb (P<0.01).2. Comparison of SOD,MDA in each group:Serum SOD in each group has descendant tendency, DMⅡgroup is lower than DMⅠgroup(P<0.05); DMⅠgroup is lower than the normal control group(P<0.05).Serum MDA in each group has ascendent tendency, DMⅡgroup is higher than DMⅠgroup(P<0.01); DMⅠgroup is higher than the normal control group(P<0.01). The ratio of SOD and MDA in each group has descendant tendency, DMⅡgroup is lower than DMⅠgroup(P<0.01); DMⅠgroup is lower than the normal control group ( P<0.01 ) .There is significant negative correlation between SOD/MDA and pathogenesis,FBG,TG,TC,BUN,Cr,urinary Alb(P<0.01 or <0.05);and the positive correlation between SOD/MDA and serum CO concentration (P<0.01).3. NOS-NO system:Comparison of serum NO,NOS concentration: DMⅠgroup is higher than DM group(P<0.05); DMⅡgroup is lower than DMⅠgroup(P<0.01). NO is negatively related to BUN,urinary Alb(P<0.01or <0.05);in contract, it is positively correlated with NOS (P<0.01). NOS is negatively related to urinary Alb(P<0.05).Conclusion:Serum CO,Fe and bilirubin concentration have descended in diabetic nephropathy groups respectively.Serum NO amount is increased in DMⅠand progressively declined in DMⅡ. CO-HO system and NO-NOS system maybe involve in the occurrence and development of diabetic nephropathy by oxidative stress.