| BackgroundIn Chinese adults,incidence of diabetes mellitus(DM)and pre-diabetes is about 50%.DM not only brings metabolism disorders,but also affects various organs of the body,leading to vascular and non-vascular complication.Diabetic kidney disease(DKD),one of the most common chronic microvascular complication of DM,is also the major cause of end-stage renal disease(ESRD).Renin-angiotensin-aldosterone system(RAAS),regulating renal hemodynamics and tubular reabsorption,plays an important role in kidney disease.To figure out the level of plasma renin activity,angiotensin II and aldosterone,120 of type 2 diabetes mellitus patients were grouped into A,B,and C according glycated hemoglobin(HbA1c).As we all know,urinary neutrophil gelatinase-associated apolipoprotein(uNGAL)is used to reflect acute renal injury.In recent years,studies have shown that uNGAL can also be applied to predict diabetic kidney injury,but the cutoff value still is disputed.Objective1.Analysis of plasma renin,angiotensin II and aldosterone in T2 DM as HbA1 c elevating.2.Exploration of uNGAL in diabetic kidney disease,compared with 24 h urine albumin.MethodsA total of 120 patients with type 2 diabetes mellitus and 30 healthy controls were enrolled who visited the First Affiliated Hospital of Zhengzhou University,from September 2015 to June 2017.The general conditions,age,gender,medical history,HbA1 c,blood biochemistry,renin,angiotension II,aldosterone,24 h urinary albumin and uNGAL of all subjects were recorded.According to HbA1 c,subjects of T2 DM were divided into three group.HbA1c<7% is group A,7%≤HbA1c<9% is group B,and HbA1c≥9% is group C.Genaral indicators were compared among A,B and C,while plasma renin activity(PRA),Angtension II(AngII)and Aldosterone(ALD)compared with control group.According to 24 h urine albumin,subjects of T2 DM were divided into three group: normoalbumin group,microalbumin group and maroalbumin group.uNGAL was calculated among three groups and correlation of uNGAL and 24 h urine albumin was analysed.According to uNGAL,All subjects were divided into five groups.0.9ng/ml≤uNGAL<25ng/ml is group one,25ng/ml≤uNGAL<50ng/ml is group two,50ng/ml≤uNGAL<75ng/ml is group three,75ng/ml≤uNGAL<100ng/ml is group four,and uNGAL≥100ng/ml is group five.Among five groups the number was counted as 24 h urine albumin is normal or not.Receiver operating curve was drew to detemin the diagnostic level of uNGAL.Correlation between uNGAL and PRA,AngII,ALD was analysed,so did 24 h urine albumin.IBM SPSS21.0 statistical software was used.One-way ANOVA,LSD-t test,Spearman rank correlation analysis,Receiver operating curve was involved.α = 0.05 as test level.Results1.With the rise of HbA1 c,total cholesterol and low density lipoprotein increased gradually with significant difference(P <0.05).2.Compared with control group,PRA and AngII rised gradually with the increase of HbA1c(P <0.05).There was no significant difference in aldosterone among groups(P>0.05).3.As 24 h urine albumin increased,uNGAL rised accordingly(P<0.05).uNGAL correlated positively with 24 h urine albumin(r=0.51,P=0.037).4.ROC curve showed that area under the curve of uNGAL was 0.900(P<0.05),95% confidence interval was(0.848,0.951);the optimal cutoff value was 62.5 ng/ml,and corresponding Youden index was 0.655,sensitivity 0.784,specificity 0.871.5.Correlation analysis showed that uNGAL correlated positively with PRA(r=0.11,P=0.016),and AngII(r=0.126,P =0.006),but correlation between uNGAL and ALD(r=-0.12,P=0.459)had no statistical difference.Conclusion1.Plasma renin and angiotension II increase as HbA1 c elevates in T2 DM.2.Increase of urinary neutrophil gelatinase-associated lipocalin is suggestive of diabetic kidney disease,which correlates positively with 24 h urine albumin. |
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