| Objective:To explore the changes of amino acids and lipids metabolism in patients with T2DM(type 2 diabetes melitus)complicated with diabetic nephropathy,and to analyse the relationship between amino acids and lipids and the incidence of diabetic nephropathy,so as to provide new ideas for the early prediction and treatment of diabetic nephropathy.Methods:A cross-sectional study was conducted to collect type 2 diabetes patients from May 2018 to January 2019 in the Endocrinology Department of the second affiliated hospital of dalian medical university,according to the internationally accepted criteria for diagnosis and classification of the WHO(World Health Organization)expert Committee on Diabetes(1999),the patients are 20 to 88 years old.First,record general data of patients in the group: name,sex,age.Then,the serum levels of creatinine,uric acid,cystatin C and hypersensitive c-reactive protein in venous blood collected from patients at an empty stomach for 8 hours in the morning were detected,at the same time collect data of serum metabolites such as amino acids,acyl carnitine and lipids detected by chromatography mass spectrometry(MS)and Nuclear magnetic resonance(NMR)spectroscopy.Random urinary albumin and creatinine were collected from patients in normal life state(avoid strenuous exercise)for Calculat of urinary ACR= Instant urinary Albumin / urinary creatinine(m g/mg).According to the diagnostic criteria of ADA(American Diabetes Association)(2012)to diagnose microalbuminuria as ACR:30-299 m g/mg,to diagnose large amount of albuminuria as ACR ≥300 m g/mg.A total of 641 cases were enrolled in this study,of which 466 cases were evaluated for amino acid,carnitine,and 175 cases were evaluated for lipid.According to the time of definite diagnosis of type 2 diabetes,patients were divided into three groups(group A: time < 5 years;group B: 5 years ≤ time < 10 years;group C:time ≥ 10 years).To analyze the changes of amino acids,lipids and carnitine metabolites in the progression of diabetic and their diagnostic significance in the three groups.The patients in group C were further divided into three groups according to the calculated ACR value(C1: diabetic nephropathy or diabetic nephropathy <Ⅲ;C2: early diabetic nephropathy group;C3: clinical diabetic nephropathy or uremic group).And then analyze the changes of amino acids,lipids and carnitine metabolites in the progression of diabetic nephropathy and their diagnostic significance in the three groups.Results:In the group with type 2 diabetes for more than 10 years,cystatin C and uric acid increased with the decrease of diabetic renal function,and the level of cystatin C and uric acid in C3 group was significantly higher than that in C1 and C2 group,and the difference was statistically significant(P < 0.01).Arginine,phenylalanine / tyrosine and butyryl carnitine / propionyl carnitine were significantly higher in group C3 than those in group C1 and C2,and there was a significant difference between group C3 and group C2(P < 0.05).Tyrosine,tyrosine / citrulline decreased as kidney function declines,and they in C3 group all lower than C1 and C2 groups,and the difference was statistically significant(P < 0.05).Glycine and succinyl carnitine were significantly different between the two groups of C1 and C2(P < 0.05),and These two things in C2 both lower than that of C1 group.And oleic acid,eicosylenoic acid,eicosenoic acid and total monounsaturated fatty acid were higher in C3 group than in C1 or C2 group,and the difference was statistically significant(P < 0.05).Conclusions:1.With the decrease of renal function,cystatin C and uric acid increased,arginine,phenylalanine / tyrosine,butyrocarnitine / propionyl carnitine increased,tyrosine / citrulline decreased.The above 7 indexes or ratios may predict theprogression of diabetic nephropathy.Glycine and succinyl carnitine may be used as early markers of diabetic nephropathy because they differ between the diabetic with no nephropathy or diabetic nephropathy less than stage Ⅲ group and the early diabetic nephropathy group.2.Oleic acid,eicosacarboxylic acid,eicosenoic acid,total monounsaturated fatty acid,these four lipid metabolites all increased with the decrease of diabetic renal function,which may be used as markers of the progression of diabetic nephropathy. |
PDF Full Text Request