The Study Of The Correlation Between Serum AGEs And Its Receptor Gal-3 With Type 2 Diabetic Kidney Disease

Objectives:In this study,We collected common clinical indicators of patients with type 2 diabetic kidney disease(DKD),detected the levels of serum advanced glycation end products(AGEs)and its receptor galectin-3(Gal-3),to investigate the correlation between AGEs,Gal-3 and DKD,so as to provide a new strategy for the early diagnosis and treatment of DKD.Methods:In this study,80 non-dialysis DKD patients admitted to the Department of Nephrology and Endocrinology of the First Affiliated Hospital of Kunming Medical University from Semtember 2019 to October 2020 were randomly collected as subjects,and collected 60 patients with primary glomerulonepfritis(PGN)admitted to the Department of Nephrology,15 patients with type 2 diabetic mellitus(T2DM)hospitalized in the Department of Endocrinology and 15 healthy people examined in the physical examination center were selected as the control group during the same period.The glomerular filtration rate(GFR)was estimated according to the CKD-EPICys formula,and the DKD and PGN groups were divided into stages G1 to G5.According to the urine albumin creatine ratio(UACR),DKD group was divided into stage A2 and stage A3.The general data and common clinical indicators of all the subjects were collected,and the serum levels of AGEs,Gal-3 and transforming growth factor-β(TGF-β)were measured by ELISA.Compared the differences of above indexes in different groups,different stages of eGFR in the DKD group,the same stages of eGFR in the DKD group and the PGN group and the DKD group at stage A2 and A3.The correlation between serum AGEs,Gal-3 and clinical indexes and classic fibrotic factor TGF-β in the DKD group was analyzed.To explore the related risk factors affecting the occurrence of DKD and the decrease of eGFR in DKD group,and to evaluate the diagnostic value of serum AGEs and Gal-3 in DKD alone or in combination.Results:1.There were statistically significant differences in serum AGEs,Gal-3 and TGF-β levels among the four groups(P<0.05).Serum AGEs and Gal-3 levels in DKD group were higher than those in the control group(P<0.05),and TGF-β level in PGN group was significantly higher than that in the other three groups(P<0.05).2.The serum levels of AGEs,Gal-3 and TGF-β at G1-G5 stage in DKD group were significantly different(P<0.05),G4 and G5 stages were significantly higher than G1 and G2 stages(P<0.05),with the decrease of renal function,the levels of AGEs,Gal-3 and TGF-β in serum showed a gradually increasing trend.3.There were statistically significant differences in serum Gal-3 and TGF-β levels between DKD group at stage A2 and A3(P<0.05),while there was no statistically significant difference in serum AGEs levels between DKD group at stage A2 and A3(P=0.056).4.The DKD group was compared with the PGN group by the same stage of eGFR.After adjusting for age,the serum AGEs levels in G2,G3 and G5 stages,the serum Gal-3 levels in G2-5 stages and TGF-β levels in G1-3 and G5 stages showed statistically significant differences(P<0.05).The levels of AGEs and Gal-3 in DKD group were higher than those in PGN group,and the levels of TGF-β in PGN group were higher than those in DKD group.5.Serum AGEs and Gal-3 levels in DKD group were positively correlated with Urea,Scr,UA,K and P(P<0.05),and negatively correlated with RBC,Hb,FPG,Ca and eGFR(P<0.05).Serum AGEs,Gal-3 and TGF-β levels were positively correlated with each other(P<0.001).6.Multivariate logistic regression analysis showed that serum FPG,AGEs and Gal-3 were independent risk factors for DKD(P<0.05).Multiple linear regression analysis showed that 68.9%of the decrease in eGFR in DKD group could be explained by serum TGF-β,UA,K,P and urinary UACR levels,and the regression equation was statistically significant(F=35.991,P<0.001).7.ROC curves were constructed,the AUC of AGEs and Gal-3 for DKD alone was 0.812 and 0.865(P<0.001),the AUC of AGEs combined with Gal-3 for diagnosis of DKD was 0.870(P<0.001).Conclusions:1.Serum AGEs and Gal-3 are independent risk factors for the occurrence of DKD and are highly expressed in DKD,suggesting possible involvement in the occurrence and development of DKD.2.Serum AGEs and Gal-3 levels in DKD patients increased gradually with renal function decline,suggesting that TGF-β,the classic fibrogenic factor,can be used as an indicator for the evaluation of renal fibrosis in DKD patients.3.As an AGEs receptor,compensatory increase of Gal-3 can increase the degradation and clearance of AGEs,which may be involved in the protective effect of DKD.4.Serum AGEs and Gal-3 have good value in single and combined diagnosis of DKD,suggesting that they may become effective markers for early diagnosis and new therapeutic targets in the future.