The Experimental Study Of Urinary Alpha-1Acid Glycoprotein In Diagnosis Of Diabetic Nephropathy In Type2Diabetic Patients

Part Ⅰ：The clinical significance of urinary Alpha-1acid glycoprotein indiagnosis of diabetic nephropathy in type2diabetic patientsObjective: To investigate the diagnostic value of urinary Alpha-1acidglycoprotein(AAG)in type2diabetic patients with diabetic nephropathy(DN).Methods:115type2diabetic patients,40healthy subjects and40patients withinfectious diseases were recruited from January2010to October2011. The urinaryAAG,serum AAG and serum C-reactive protein(CRP)were measured for all subjects.Additional24-hour urinary albumin excretion rate(UAER)was detected for type2diabetic patients. Type2diabetic patients were further divided into3subgroupsaccording to UAER: normal albuminuric(NAU) group,microalbuminuric(MAU)group and macroalbuminuric(MaAU)group. The clinical significance of urinaryAAG was evaluated by analyzing the difference of urinary AAG between healthysubjects and type2diabetic patients,the three subgroups of type2diabetic patients.The impact of serum AAG to the level of urinary AAG was also investigated.Results: The level of urinary AAG in type2diabetic patients was significantlyhigher than healthy group,however,there was no statistical significance betweenNAU group and healthy group. The level of urinary AAG in type2diabetic patientswas positively correlated with UAER,and the difference of urinary AAGconcentration between NAU,MAU and MaAU groups was statistical significance.When excluding the infectious factors,there was no significant difference in the levelof serum AAG between T2DM group and healthy group. The variation of serum AAGhad no significant impact on urinary AAG detection.Conclusion: Urinary AAG can used as assistant diagnostic indicator of T2DMand DN. Moreover, urinary AAG can also find its value in DN staging.Part Ⅱ: The clinical significance of urinary Alpha-1acid glycoprotein inpredicting the progression of diabetic nephropathy in type2diabetic patients Objective: To investigate the value of urinary Alpha-1acid glycoprotein(AAG)in predicting the progression of diabetic nephropathy(DN)in type2diabetic (T2DM)patients.Methods: The levels of urinary AAG were detected by enzyme-linkedimmunosorbent assay,and its average value and standard deviation were respectivelycalculated and called AAGh/SDhand AAGd/SDdin40healthy persons and40T2DMpatients with UAER in20μg/min-200μg/min. Takes AAGh+2SDhand AAGd+2SDdas urinary upper limit of AAG reference scope in healthy persons and in T2DMpatients respectively. T2DM patients were further divided into3subgroups refering toUAER the grading standards: NAAGU group(AAG<AAGh+2SDh),MAAGUgroup(AAGh+2SDh≦AAG≦AAGd+2SDd) and MaAAGU group (AAG>AAGd+2SDd).100T2DM patients were recruited. T2DM patients were further divided into3subgroupsaccording to the levels of urinary AAG: NAAGU group,MAAGU group andMaAAGU group,and carries on a two year follow-up study to these object of study.Urinary microalbumin and creatinine were decteted every six months in follow-upperiod. Try to study the extent of damage of kidney function in patients with differenturinary AAG level, in the hope of making clear the value of urinary AAG inpredicting the development and progression of DN in T2DM patients.Results: Average value and standard deviation of urinary AAG in40healthypersons and40T2DM patients were74.58l±16.17μg/ml and116.53±28.47μg/mlrespectively. According to the above, T2DM patients with urinary AAG<106.92μg/ml were grouped into the NAAGU group, AAG>173.47μg/ml intoMaAAGU group, and106.92μg/ml≦AAG≦173.47μg/ml into MAAGU group.Therate of ACR progress of T2DM patient in the NAAGU group, MAAGU group andMaAAGU group were respectively7.14%,16.67%and37.5%in a two yearfollow-up study. The rate of ACR alleviation of T2DM patient was8.33%in theNAAGU group. The T2DM patients in MaAAGU group did not show alleviation.Conclusion: The levels of Urinary AAG was positive related with the kidneyfunction harm in T2DM patient, and kidney function harm alleviate with a reductionof Urinary AAG level.The determination of urinary AAG has a good value inpredicting the development and progression of DN in T2DM patients.