The Evaluation Of Clinical Application Of Laboratory Indicators For Early Diagnosis Of Diabetic Kidney Disease

Objective: To explore the laboratory indicators for diagnosis of diabetic kidney disease(DKD)in order to improve the reliability and accuracy of early clinical diagnosis.Methods:225 patients with diabetes mellitus(DM)were selected from department of endocrinology of the first affiliated hospital of bengbu medical college from February2014 to October 2014.On admission,the age,sex,body mass index(BMI),course of disease,systolic blood pressure(SBP),diastolic blood pressure(DBP)were collected,total cholesterol(TC),triglyceride(TG),serum cystatin C(Cys-C)and serum retinol binding protein4(RBP4),serum creatinine(Scr),Serum urea(Sur),serum uric acid(SUA),hemoglobin A1c(HbAlc),fasting plasma glucose(FPG),24 hours urine micro albumin(UmAlb)level were determined in all selected subjects.GFR values were measured using a renal dynamic imaging method.According to the GFR value all patients were divided into three groups: group A(GFR<60,53 cases),group B(60≤GFR<90,106 cases),group C(GFR≥90,66 cases).According to 97 cases of patients with diabetic normal albuminuria(UmAlb<30mg/24)and 203 cases of patients with diabetic creatinine normal(Scr≤104umol/L)),GFR<60 and GFR≥60 were divided into two groups respectively.The differences,advantages and disadvantages of all indicators were obtained throught test,analysis of variance,correlation analysis,multiple stepwise regression analysis,the receiver operating characteristic curve(ROC curve).Result:1.Compared with the GFR,the age,course of disease,Serum Cys-C,serum RBP4,Scr,Sur,SUA,UmAlb,SBP,DBP showed negative correlation(p<0.05).HbAlc,FPG showed positive correlation with GFR(p<0.05).The multiple stepwise regressionanalysis indicated that serum Cys-C,age,UmAlb,HbAlc were into the best model,the most significant indicator was Cys-C.2.Serum Cys-C,age,UmAlb,HbAlc,there were statistical difference in A,B,C groups.Serum Cys-C,age,UmAlb levels of group A were higher than that of group B and group C respectively,the group B were higher than the group C(p<0.05);HbAlc level of group A was higher than that of group B and groupC(p<0.05).3.In group A,serum Cys-C level was negatively correlated with GFR,HbAlc was positively correlated with GFR(p<0.05);serum Cys-C,UmAlb of group B were negatively correlated with GFR(p<0.05);age of group C was negatively correlated with GFR.Compared with GFR,there was not statistically significant in other indicators(p>0.05).4.ROC curve showed serum Cys-C,age,UmAlb for evaluation of renal function(GFR<60)was of diagnostic significance.The area under the ROC curve(AUC)of Cys-C was the biggest one.Cys-C =1.05mg/L was to predict the best diagnostic cut-off point of chronic kidney disease.5.Analysis of 97 diabetics with normal albuminuria subgroup showed,Scr,serum Cys-C levels of the patients with GFR<60 were significantly higher than that of the patients with the GFR≥60(p<0.05).Cys-C= 1.05mg/L was used as a detection standard in renal damage,the detection rate was 22.68%.6.Analysis of 203 diabetics with normal creatinine subgroup showed,Sur,SUA,serum Cys-C,erum RBP4 levels of the patients with GFR<60 were significantly higher than that of the patients with the GFR≥60(p<0.05).Cys-C= 1.05mg/L was used as a detection standard in renal damage,the detection rate was 30.54%.Conclusion: 1.Age,course of disease,serum Cys-C,serum RBP4,Scr,Sur,SUA,UmAlb,SBP,DBP,HbAlc,FPG and GFR are closely related,in which serum Cys-C,age,UmAlb,HbAlc have a significant impact on diabetic renal function,and serum Cys-C has the greatest impact.2.Serum Cys-C=1.05mg/L can be used as a critical point in the clinical diagnosis of diabetic kidney disease,and it is of certain clinical value to monitor the disease development.3.In the early stage of diabetic kidney disease,the rise of serum cystatin is earlier than UmAlb,and it can help to achieve the early diagnosis of DKD.