Clinical Significance Of Visfatin,Cystatin C, L-FABP, And RBP In Combination With HbA1c In The Diagnosis Of Early Diabetic Nephropathy Significance

Objective To explore the complex relationship between changes in the content of serum visfatin（Visfatin）,serum cystatinC（Cys-C）,urine retinol-binding protein（RBP）,urine-type fatty-acid binding protein（L-FABP）,glycosylated hemoglobin type A1c（HbA1c）and the occurrence of diabetic nephropathy（DN）,it is expected to find more sensitive,more specific diagnostic indicators and test combination for diabetic nephropathy.Methods According to the internationally accepted diagnostic criteria of Mogensen DN,groups were divided according to the content of 24-hour urinary microalbumin:Type 2Diabetes Mellitus（T₂DM）patients with urinary microalbumin content<30mg/24h were in the pure Diabetes group（pure DM group）,type 2 diabetic patients whose urine microalbumin content is 30mg/24h-300mg/24h are in the early diabetic nephropathy group（early DN group）,and Type 2 diabetic patients with>300mg/24h of microalbumin in urine were diabetic nephropathy group（DN group）,each group consisting of 60 people;At the same time,50 healthy subjects were selected as the normal control group.The biochemical indicators of Visfatin,RBP,L-FABP,Cys-C,HbA1c,BUN,Crea,GLU,andβ₂MG were detected in each group.The results were analyzed by statistical methods,and the differences and correlations between the indicators among the groups were analyzed.Result（1）The levels of Visfatin and L-FABP in the pure DM group were higher than that in the normal control group（P<0.05）,the early DN group was significantly higher than the pure DM group and the normal control group（P<0.001）,and the DN group was significantly higher than the other three groups（P<0.001）;There was no significant difference in the levels of Cys-C and RBP between the normal control group and the pure DM group（P>0.05）.Levels of Cys-C and RBP in early DN group was significantly higher than the pure DM group and the normal control group（P<0.001）,and the DN group was significantly higher than the other three groups（P<0.001）.There was no significant difference in HbA1c between the pure DM group and the early DN group（P>0.05）,The level of HbA1c in the pure DM group and the early DN group was significantly higher than that in the normal control group（P<0.001）,The HbA1c level of DN group was significantly higher than that of the other three groups（P<0.001）.（2）There was no statistically significant difference in the Crea level between the normal control group,the pure DM group and the early DN group（P>0.05）,The Crea level in DN group was significantly higher than the other three groups（P<0.001）;There was no statistically significant difference between BUN in the pure DM group and the early DN group（P>0.05）,The level of BUN in the DN group was significantly higher than that in the other three groups（P<0.001）,The level of BUN in pure DM group,early DN group and DN group was significantly higher than that in normal control group（P<0.001）;There was no significant difference in GLU level between the pure DM group,the early DN group and the DN group（P>0.05）,The level of GLU in the pure DM group,the early DN group and the DN group was significantly higher than that in the normal control group（P<0.001）;There was no significant difference betweenβ₂MG in normal control group and DM group（P>0.05）,The level ofβ₂MG in the early DN group was significantly higher than that in the normal control group and the pure DM group（P<0.001）.The level ofβ₂MG in the DN group was significantly higher than that in the other three groups（P<0.001）.（3）The positive rate of HbA1c,urine RBP and serum Cys-C combined detection was higher than that of single detection or pairwise combined detection of HbA1c and other two items,and the difference was statistically significant（P<0.05）.The positive rate of HbA1c,urine RBP and serum Visfatin combined detection was higher than that of single detection or pairwise combined detection of HbA1c and other two items,and the difference was statistically significant（P<0.05）.The positive rate of HbA1c,urine L-FABP and serum Cys-C combined test was higher than that of single detection or HbA1c combined with other two tests,and the difference was statistically significant（P<0.05）.The positive rate of HbA1c,urine L-FABP and serum Visfatin combined detection was higher than that of single detection or combined detection of HbA1c and other two items,and the difference was statistically significant（P<0.05）.The positive rates of the four test combinations were pairwise compared,and the difference was not statistically significant（P>0.05）.Conclusion（1）Cys-C,Visfatin,RBP and L-FABP have predictive value for the diagnosis of early diabetic nephropathy,and can reflect the severity of diabetic nephropathy,which is of great significance for the staging diagnosis of diabetic nephropathy.（2）Cys-C or Visfatin combined with RBP or L-FABP and HbA1c can improve the positive rate of diabetic nephropathy,which can be used as a combination for clinical screening of early diabetic nephropathy.