The Significance Of Hepatokines In The Diagnosis Of Early Diabetic Nephropathy

Objective: Diabetes Mellitus(DM),as a metabolic disease,can cause chronic damage to various tissues and organs and cause dysfunction.Diabetic nephropathy(DN)is one of the most common complications in the clinic.The earliest manifestation is the appearance of albuminuria.In this experiment,the levels of Hepatokines: Fetuin-A,Fibroblast Growth Factor 21(FGF-21)and Betatrophin in serum of patients with early diabetic nephropathy were measured.The comparison,the correlation between the three factors,and the significance of the three factors in the early diagnosis of DN were evaluated by the ROC curve to explore the effects of the three hepatocyte factors on the development of diabetic nephropathy.Methods: In this study,50 patients(28 males and 22 females)who were health check-ups from the physical examination center of our hospital from June 2018 to November2019 were used as the control group(Group A)(age 51.73±2.15years);The clinical guidelines for the prevention and treatment of diabetic and renal diseases in China in 2019 related to the diagnostic criteria for diabetic nephropathy,taking UAER<30mg/24 h as the node,and selecting 50 patients with simple type 2 diabetes(24 males and 26 females)who were admitted for treatment in the same period.Group(Group B)(age 51.93±2.31 years);taking UAER30-300mg/24 h as the node,50 patients with early diabetic nephropathy(25 males and25 females)who were admitted to the nephrology department of our hospital during the same period were selected as the observation group(Group C)(age 52.40±3.07 years).Exclusion criteria:(1)patients aged <18 or> 65 years;(2)patients who have been treated with related drugs in the past month: such as hypoglycemic agents,antihypertensive drugs,lipid-lowering drugs,etc.;(3)during pregnancy or Lactating patients;(4)patients with type 1 diabetes,other special types of diabetes,acute diabetic complications such as diabetic ketoacidosis,hypertonic coma;(5)various types of urinary infections,obstructive diseases and nephritis,Renal vascular stenosis and other patients;(6)combined with other system diseases: such as cardiovascular and cerebrovascular diseases,patients with mental illness or patients with severe liver and pulmonary dysfunction.The biomedical ethics committee of our hospital has approved the study for clinical trials.The basic human parameters of all subjects were measured uniformly,and biochemical indicators such as urinary creatinine,urinary albumin,fasting blood glucose,blood glucose two hours after a meal,and blood lipids were measured.The ratio of urinary albumin to creatinine was determined by immunoturbidimetry(UACR),the glomerular filtration rate(GFR)was calculated using the CKD-EPI formula,and the levels of Fetuin-A,FGF-21 and Betatrophin in the serum of all subjects were detected by enzyme-linked immunosorbent assay(ELISA).Results:(1)In the basic clinical indicators and laboratory test indicators: compared with group A,group B and group C BMI,waist-hip ratio,systolic blood pressure,fasting blood glucose,2-hour blood glucose,total cholesterol,triglycerides,LDL and UACR were significantly increased,while HDL was significantly decreased(P<0.05);compared with group B,only UACR was significantly increased in group C(P<0.05).(2)Comparison of Fetuin-A,FGF-21,and Betatrophin protein expression levels in serum measured by ELISA kit:Compared with group A,Fetuin-A,FGF-21,and Betatrophin protein levels in serum of group B and C The expression levels of Fetuin-A,FGF-21,and Betatrophin in serum of group C were significantly higher than those in group B(P<0.05).And the liver factors Fetuin-A,FGF-21 and Betatrophin were correlated with each other(P<0.05).(3)The diagnostic efficacy of three factors on early DN was tested separately.When the diagnostic efficacy of three factors on early DN was tested,there was no statistical significance in the sensitivity and specificity of serum Betatrophin,Fetuin-A,FGF-21(P> 0.05),but the specific P value of Betatrophin in serum is 0.0585,although it is not statistically significant but close to the test level of 0.05,it can be considered that Betatrophin has the highest specificity.The sensitivity and specificity of Fetuin-A+FGF-21+Betatrophin,Fetuin-A+FGF-21,Fetuin-A+Betatrophin,FGF-21+Betatrophin were not statistically significant in the parallel and serial tests P> 0.05),indicating that there is no significant difference in the efficacy of the combined detection of three hepatocyte cytokines.Conclusion: The expression levels of Hepatokines(Fetuin-A,FGF-21 and Betatrophin)in the serum of patients with early diabetic nephropathy are closely related to the occurrence and development of early diabetic nephropathy.The values of Fetuin-A,FGF-21 and Betatrophin are positively correlated with the UACR value,in a certain range.It reflects the severity of renal impairment and can be used as an important biological indicator for the diagnosis of early diabetic nephropathy.Fetuin-A,FGF-21,and Betatrophin in serum have no significant differences in sensitivity and specificity.Therefore,all three factors can be used as biochemical indicators for early diagnosis of DN alone,providing more evidence for early diagnosis of diabetic nephropathy.