The Correlation Of Serum IL-18、CysC、RBP And NGAL For The Patients With Diabetic Nephropathy

Background According to statistics, the diabetes(diabetes mellitus, DM) patients of our country had reached the highest peak of the world since 2008. Diabetic nephropathy(diabnephrathy, DN) were one of the most common and serious microvascular complications of DM,which were also the main reason resulting in patients with disability or death. But the domestic and foreign research showed that early detecting and delaying DN could significantly reduce the number of patients reaching end-stage renal disease. There were a lot of indexes of early diagnosis about DN. However, the sensitivitys and specificity of each were not identical. This paper would explore the serum levels of interleukin 18(IL-18), Cystatin C(Cys C), retinol binding protein(RBP), neutrophil gelatinase associated lipocalin(NGAL) in DN through jointing detection to provide further understanding in the early prevention of DN.Purpose This paper observed the serum IL-18、Cys C、RBP and NGAL in the patients with DM to explore the relation between the four indicators and the occurrence and development of DN and compare with UAER,Scr, BUN. To define the sensitivity the four indicators for diagnosis of early DN, it could provide practical base and new ideas for the early diagnosis of clinical diseases.Methods We selected the patients 117 cases(57 cases of male, 60 cases were female), aged 30 ~ 87, the average age(54.67±11.33) from March 2013 to October 2014 in our hospital. They were in accordance with the diagnostic criteria of DM patients with type 2 diabetes mellitus(T2DM) organizationed by the world health organization in 1999. These patients needed to despite recent history(high-dose glucocorticoids, vitamin B12, renal toxicity drugs, immunosuppressants), severe infection and other complications. We also choosed 33 cases as control group, including 16 cases of male, female 17 cases, aged 26 to 87, average age(50.58±16.01) from our hospital medical center at the same time, and without diabetes, hypertension, glomerulonephritis, and other metabolic diseases, heart cerebrovascular disease, etc. In accordance with the different degree of UAER announced by Mogensen’s DN staging criteria in 1989, we divided the following three groups: group A: simplex type 2 diabetes group(UAER < 30 mg / 24 h)(SDM), a total of 40 cases(male 20, female 20), average age(54. 83±13.88). Group B: early diabetic nephropathy group(UAER 30~300 mg /24 h)(EDN), a total of 39 cases(male 17, female 22), the average age(53.74±11.3). Group C: clinical diabetic nephropathy group(UAER > 300 mg / 24 h)(CDN), a total of 40 cases(male 20, female 18), the average age(55.45±8.16).We recorded strictly the patient’s general condition(such as gender, age, height, weight, systolic pressure, diastolic blood pressure, etc.) in the control and DM group. Then we calculated the patient’s body mass index(BMI) by height, weight of the control and DM group: BMI = weight/height(kg/m2). All of the biochemical indexes were pumped from elbow venous blood on an empty stomach. In addition, we posted a 24-hour urine, recorded the total urine after blending, tested urine trace albumin, and finally calculated the urinary albumin excretion rate.Results The control group and patients with DM groups in age, sex ratio, BMI, diastolic blood pressure had homogeneous base(p > 0.05),and systolic blood pressure show the trend of increased obviously(P < 0. 05). BUN, Scr and UA in the four groups(control group, SDM, EDN, CDN) increased in turn,, especially the CDN group were significantly higher than the other three groups(P < 0.05). UAER in SDM group were higher than the control group, but no statistical significance(p > 0.05). The UAER in the EDN group were obviously different from control and SDM group(P < 0.05). UAER in CDN group were significantly higher than the other three groups, and the difference was statistically significant(P < 0.05). IL-18, Cys C in the control, SDM, EDN and CDN group increased in turn, and the differences were statistically significant between EDN and control group, the SDM(P < 0.05) and the difference had statistical significance between the CDN group and the other three groups(P < 0.05). RBP, NGAL increased in the control group and DM group in turn, and the differences were statistically significant between SDM and control group(P < 0.05), and the differences were statistically significant between EDN and control group, the SDM(P < 0.05), and the difference had statistical significance between the CDN group and the other three groups(P < 0.05).Serum IL-18, Cys C, RBP, NGAL and BUN, Scr, UA and UAER were positively correlated, and there were no correlation with age, sex and BMI. DM groups of ROC curve showed that the four index about serum IL-18, Cys C, RBP, NGAL were significantly higher than serum creatinine in diagnosis of sensitivity.Conclusions 1. IL-18, Cys C, RBP, NGAL were more reliable and sensitive than UAER in DN early diagnosis. UAER, Scr, BUN had not yet appeared,we should be to take early and effective prevention to DM patients. 2. The United detect IL-18, Cys C, RBP, NGAL had higher diagnostic accuracy and sensitivity to DN, and helped the early detection of kidney damage of DM.