| Objective:The purpose of this study was to investigate the correlation between Serum neutrophil-gelatase-associated lipocalin(NGAL),haptoglobin(HPT)levels,perirenal adipose tissue(PrAT)and the development of diabetic kidney disease(DKD)in patients with type 2 diabetes mellitus(T2DM),with the aim of providing a theoretical basis for the clinical management of DKD disease in patients with T2DM and their high-risk groups.Methods:A total of 190 patients with T2DM admitted to the Department of Endocrinology,the Second Hospital of Shandong University from January 2022 to November 2022 were selected for study and analysis.The patients were divided into 114 patients with diabetes mellitus alone(DM alone group),45 patients with early diabetic kidney disease(early DKD group)and 31 patients with clinical diabetic kidney disease(clinical DKD group)according to the urinary albumin-to-creatinine ratio(UACR)level.Serological parameters such as NGAL,HPT,residual cholesterol(RC),non-esterified fatty acids(NEFA),etc.were detected in all enrolled patients.The visceral fat area and subcutaneous fat area were measured by Omron DUALSCANHDS-2000 body composition analysis instrument,and the visceral fat thickness indexes in different parts were measured by LOGIQ E9 color Doppler ultrasound diagnostic instrument of GE company.The relationship between NGAL,HPT,PrAT and other study indicators and type 2 diabetic kidney disease was analysed.Spearman correlation was used to analyze serological indexes such as serum NGAL,HPT,RC,NEFA,TC,TG,LDL-C,HDL-C and the relationship between PrAT and the occurrence and development of DKD.Multivariate logistic regression analysis was used to explore the risk factors for the development of DKD.ROC curve was used to evaluate the predictive value and diagnostic efficiency of NGAL,HPT,PrAT and combined indicators in the development of DKD in patients with T2DM.Results:1.The results of the multiple group comparison showed that the NGAL,HPT and PrAT levels in the clinical DKD group were significantly higher than those in the DM-only group,and the differences were statistically significant(p<0.05).The HPT levels in the clinical DKD group were significantly higher than those in the early DKD group,and the differences were statistically significant(p<0.05).The NGAL and PrAT levels in the early DKD group were significantly higher than those in the DM-only group,and the differences were statistically significant(p<0.05).2.Correlation analysis showed that NGAL was positively correlated with the severity of UACR in T2DM patients(r=0.474,p<0.001),HPT was positively correlated with the severity of UACR in T2DM patients(r=0.275,p<0.001),and PrAT was positively correlated with the severity of UACR in T2DM patients(r=0.421,p<0.001).3.Binary logistic regression analysis showed that elevated serum levels of NGAL,elevated levels of BUN and thickened PrAT were statistically significant(p<0.05)in relation to the development of DKD in patients with T2DM;and higher levels of serum NGAL(OR=1.014,95%CI 1.006-1.023),BUN(OR=1.271,95%CI 1.027-1.574)and PrAT(OR=9.300,95%CI 3.204-26.998)were risk factors for the development of DKD in patients with T2DM.4.Multiple logistic regression analysis of factors influencing the development of different degrees of DKD in patients with T2DM showed that higher levels of NGAL(OR=1.017,95%CI 1.007-1.026,p<0.05),HPT(OR=3.347,95%CI 1.045-10.719,p<0.05),UA(OR=1.008,95%CI 1.000-1.016,p<0.05)and PrAT(OR=10.809,95%CI 2.205-52.990,p<0.05)were independent risk factors for the development of clinical DKD in T2DM patients,whereas increased body weight(OR=0.913,95%CI 0.865-0.964,p<0.05)was a protective factor for the development of clinical DKD in T2DM patients.5.The area under the ROC curve for NGAL in the development of DKD disease in T2DM patients was 0.720,95%CI 0.643-0.796,sensitivity 0.645 and specificity 0.763.The area under the ROC curve for HPT in the development of DKD disease in T2DM patients was 0.651,95%CI 0.571-0.731,sensitivity 0.697 and specificity 0.561.The area under the ROC curve for PrAT in predicting DKD disease in patients with T2DM was 0.727,95%CI 0.651-0.803,sensitivity 0.592 and specificity 0.781.The area under the ROC curve of the combined index including NGAL,HPT and PrAT in predicting DKD disease in patients with T2DM was 0.807,95%CI 0.742-0.871,sensitivity 0.803 and specificity 0.702.The area under the ROC curve of the combined index was the largest,showing that the combined index of the three was more effective in predicting the development of DKD in T2DM.Conclusion:1.NGAL,HPT and PrAT levels in T2DM patients were positively correlated with the level of UACR.As UACR progressed in T2DM patients,NGAL and HPT levels increased and patients had increased perirenal adipose thickness.2.NGAL,HPT and PrAT were positively correlated with disease progression in DKD.NGAL,HPT and PrAT were independent risk factors for type 2 diabetic kidney disease.3.The combined index of NGAL,HPT and PrAT has a better predictive value for the combination of DKD in patients with T2DM,providing new ideas and scientific basis for clinical practice. |
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