| ObjectiveTo examine the value of serum neutrophil gelatinase-associated lipocalin(NGAL),cystatin C(Cys-c)and uric acid(UA)in the early diagnosis of diabetic kidney disease(DKD).MethodsThe clinical data of 193 participants with type 2 diabetes mellitus(T2DM)confirmed in Taizhou People’s Hospital from January 2017 to December 2018 were retrospectively analyzed.According to the urinary albumin excretion rate(UAER),those participants were classified into normal albuminuria(NA)group(n=65),microalbuminuria(MA)group(n=66)and clinical nephropathy(CN)group(n=62).Serum NGAL,Cys-c,UA,urea nitrogen(BUN),serum creatinine(SCr),estimate glomerular filtration rate(e GFR),fasting blood-glucose(FPG),fructosamine,hemoglobin a1c(Hb A1c),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholestero(HDL-C)levels were measured and compared among the three groups.The correlation between NGAL,Cys-c,UA and other renal indexes was analyzed by pearson’s linear analysis.Multiple stepwise regression was used to analyze the influencing factors for UAER.Logistic binary regression was used to explore the risk factors for DKD in renal index.Receiver operating characteristic(ROC)curve was employed to evaluate the diagnostic efficiency of single or combined NGAL,Cys-c and UA for DKD,and the diagnostic thresholds of the three indicators in T2 DM patients were determined.Results1.The levels of NGAL,Cys-c and UA were 49.83(25.79,66.84)ng/m L,(0.93±0.17)mg/L,(301.37±75.02)μmo L/L in NA group,81.56(64.20,100.71)ng/m L,(1.06±0.32)mg/L,(305.77±70.34)μmo L/L in MA group,and 158.59(104.97,221.18)ng/m L,(1.89±0.77)mg/L,(375.00±115.87)μmo L/L in CN group,respectively.The differences among groups were statistically significant(P<0.05).However,Compared with the NA group,only NGAL level was significantly increased in the MA group(P<0.05),while there was no significant difference in Cys-c and UA(P>0.05).2.Pearson’s linear analysis found the serum NGAL,Cys-c and UA levels were positively correlated with UAER,BUN and SCr(0.502,0.574,0.399;r=0.414,0.421,0.484;r=0.407,0.480,0.567),while negatively with e GFR(r=-0.360,-0.420,-0.430).The difference was statistically significant(P<0.05).3.The NGAL,Cys-c,TG and LDL-C were significantly related to UAER based on multiple regression analysis(P<0.05).4.Logistic regression analysis showed that NGAL and Cys-c without adjustment were independent risks for early DKD(OR=1.042,P=0.000;OR=9.417,P=0.011).Similar results were obtained after adjusting for blood pressure and blood lipid(NGAL,OR=1.044,P=0.000;Cys-c,OR=15.669,P=0.005).5.With UAER≥20μg/min as the cut-off point,patients were divided into NA group and DKD group(MA group +CN group)for ROC curve analysis.The areas under the ROC curve for UA,Cys-c,NGAL,NGAL+UA,NGAL+Cys-c,and NGAL+Cys-c+UA combined detection in early DKD were 0.608,0.724,0.873,0.871,0.889,0.890,respectively.The single detection found high sensitivity of NGAL(79.8%),high specificity of Cys-c(98.5%),and the NGAL+Cys-c+UA combined detection showed the highest diagnostic efficiency(AUC=0.890).When Youden index was the highest,the cut-off values of serum NGAL,Cys-c and UA were 70.10ng/L,1.21mg/L and 299μmol/L,respectively.ConclusionSerum NGAL,Cys-c and UA could demonstrate the renal injury degree in diabetics,but only NGAL can reflect the occurrence of early DKD,suggesting that both glomerular and renal tubule damage exists in early DKD.NGAL is a stable independent predictor for DKD.The combined detection of serum NGAL,Cys-c and UA can exert the maximum diagnostic efficiency,which can be used for diagnosing DKD and assessing the degree of renal injury.This finding will play an important guiding significance in clinical work. |
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