Value Of Serum RNLS And NGAL In Early Diagnosis Of Diabetic Kidney DiseaseValue Of Serum Rnls And Ngal In Early Diagnosis Of Diabetic Kidney Disease

Objective:Serum renalase(RNLS)and serum neutrophil gelatinase-associated lipocalin(NGAL)of patients with Simple type 2 diabetes and different stages of diabetic kidney disease(DKD)were measured to explore the correlation between levels of serum RNLS and serum NGAL and the development of DKD.Furtherly,Whether serum RNLS and serum NGAL could be used as indicators for early diagnosis of DKD or not.Methods:A total of 164 inpatients diagnosed with T2DM in Ya ’an People’s Hospital from January 2021 to December 2021 were selected.Including 144 T2DM patients with eGFR≥60mL/min/1.73m2 and 20 T2DM patients with eGFR<60mL/min/1.73m2.According to urinary albumin/creatinine ratio(UACR),164 T2DM patients were divided into 3 groups:①Simple type 2 diabetes group(group A,UACR<30mg/g and eGFR≥60mL/min/1.73m2),48 patients;②Early diabetic renal injury group(group B,30mg/g≤UACR≤300 mg/g and eGFR≥60mL/min/1.73 m2),70 patients;③Clinical diabetic nephropathy group(group C,UACR>300mg/g),46 patients.According to eGFR,group C was divided into group C1 and group C2.group C1(UACR>300 mg/g and eGFR≥60mL/min/1.73 m2),26 patients;group C2(UACR>300 mg/g and eGFR<60mL/min/1.73 m2),20 patients.50 healthy people were included as healthy control group(HC group).Levels of serum RNLS and serum NGAL were measured by enzyme-linked immunosorbent assay(ELISA).Spss26.0 statistical software was used for data analysis and processing:①Comparing the clinical datas of 3 subgroups of T2DM(group A,group B and group C);②Comparing levels of serum RNLS and serum NGAL:the whole T2DM group and HC group,levels of serum RNLS and serum NGAL in three subgroups of T2DM and HC group,and levels of serum RNLS and serum NGAL in three subgroups of T2DM;③Comparing the changes of serum RNLS and serum NGAL in patients with different eGFR levels(group C1 and group C2);④Using spearman correlation to analyze the correlation between levels of serum RNLS and serum NGAL and renal indicators(UACR,BUN,eGFR,Scr and UA)in T2DM patients;⑤Using logistic regression to analyze the influencing factors of DKD;⑥Using receiver operating characteristic(ROC)curve to analyze the diagnostic efficacy of serum RNLS and serum NGAL alone and in combination for DKD.Result:1.Comparison of clinical datas of 3 subgroups of T2DM(group A,group B and group C):Levels of Scr and BUN in group C were higher than those in group B,and levels of eGFR in group C were lower than those in group B.the differences were statistically significant.(P<0.05).There were no significant differences in eGFR,Scr and BUN levels between group A and group B(P>0.05).2.Comparison of serum RNLS levels and serum NGAL levels between T2DM group and HC group.2.1 Comparison of serum RNLS levels and serum NGAL levels between the whole T2DM group and HC group:serum RNLS levels and serum NGAL levels in the T2DM group were higher than those in HC group,the difference was statistically significant(P<0.05).2.2 Comparison of serum RNLS levels and serum NGAL levels between the three subgroups of T2DM and the HC group:the serum RNLS levels and serum NGAL levels of the group B and the group C were higher than those of the HC group,the difference was statistically significant(P<0.05).There were no significant differences in serum RNLS and serum NGAL levels between group A and HC(P>0.05).2.3 Comparison of serum RNLS levels and serum NGAL levels in 3 subgroups of T2DM:Serum RNLS levels and serum NGAL levels in group C were higher than those in group B,and those in group B were higher than those in group A,the differences were statistically significant(P<0.05).3.Comparison of serum RNLS levels and serum NGAL levels in patients with different eGFR levels(group C1 and group C2):serum RNLS levels and serum NGAL levels in group C2 were higher than those in group C1.the differences were statistically significant(P<0.05).4.Serum RNLS levels and serum NGAL levels were positively correlated with UACR,BUN,Scr and UAlevels in T2DM patients(r=0.899、0.410、0.413、0.314;r=0.749、0.517、0.481、0.336),negatively correlated with eGFR(r=-0.435,-0.469,P<0.05).5.The course of T2DM,DBP,SBP,BUN,Scr,UA,TG,serum RNLS and NGAL were all influential factors of DKD,and increase of serum RNLS level was an independent factor of DKD.6.The sensitivity of serum NGAL,serum RNLS and their combination in the diagnosis of early DKD were 52.9%,98.6%and 100%,the specificity 89.6%,91.7%and 89.6%,and AUC 0.747,0.980 and 0.980 respectively.The best cutoff values of serum NGAL and serum RNLS were 39.3535 ng/mL and 10.7495μg/mL respectively.Conclusion:1.In T2DM patients,the changes of serum RNLS levels and serum NGAL levels are earlier than those of Scr,BUN and eGFR,which can be used as markers for the early diagnosis of DKD.2.Serum RNLS and serum NGAL were correlated with the levels of UACR,BUN,Scr,UA and eGFR.and their changes could reflect the degree of proteinuria and kidney injury in DKD patients and the occurrence and progression of DKD.3.The sensitivity and specificity of serum RNLS and serum NGAL for the early diagnosis of DKD were both higher,and the diagnostic efficiency of serum RNLS was better than that of serum NGAL.The combined detection of serum RNLS and serum NGAL could increase the sensitivity of the early diagnosis of DKD,and could be used for the screening and diagnosis of early DKD.