| Objective Although patients with diabetic nephropathy(DN) strict metabolic control and strict treatment of hypertension, DN progress maintained a serious clinical problem. More and more evidence that the DN is a multi-factor disease, it's pathological mechanism is unclear today. Recent studies have confirmed that kallikrein-kinin system(KKS) plays an important role in the DN progress.KLK1 play in the diabetic state in addition to its effect in renal hemodynamic activity than the product through its regulation of glomerular mesangial cells, renal tubular epithelial proliferation and participate in the progress of DN. Therefore, to explore KLK1 in DN and its clinical significance in research of mechanisms of DN progress to provide a basis to treatment the disease.In this study we determine blood level of KLK1 in patients with DN to analysis it's change on different stages of DN and its correlation with UAER,HbA1c,PP and Cr in DN for clinic implication.Methods According to DN clinic stages,divided 64 newly diagnosed type 2 diabetes mellitus(T2DM) patients who enrolled in Guangxi Zhuang Autonomous Region Nanxishan Hospital and received system treatment during Mar.2009 to Dec.2009 into three groups(normal proteinuria group,micro proteinuria group and large proteinuria group). Normal proteinuria group: 23 males and 9 females, average age was 54(43-65)years old, UAER level range from 0μg/min to 20μg/min; Micro proteinuria group:12 males and 8 females, average age was 57(45-69)years old,UAER level range from 20μg/min to 200μg/min; Large proteinuria group:4 males and 8 females, average age was 59(50-68)years old, UAER level higher than 200μg/min. UAER is determined by immunoturbidimetry continuing 3 days(only morning urine per day) to get the mean of it. Age,BMI,24h SBP and 24h DBP was acquired from patients'medical records. PP was 24h SBP minus 24h DBP. Cr was determined by Hitach 7810A automatic biochemistry analyzer. HbA1c was determined by Ion-exchange high performance liquid chromatography. In addition,collect 23 healty people who had underwent medical examination on the same period for control group including 15 males and 8 females,average age was 53(age:43-63)years old.KLK1 concentration was determined by ELISA(Double-Well). Data was analyzed using analysis of variance and correlation analysis with SPSS 17.0 in Windows XP.Results It was showed that KLK1 level of large proteinuria group in DN patients was significantly higher than that of micro proteinuria group(16.93±6.64ng/ml V.s 10.67±5.19ng/ml,P<0.05).KLK1 level of micro proteinuria group in DN patients was significantly higher than that of normal proteinuria group(10.67±5.19ng/ml V.s 6.74±3.08ng/ml,P<0.05).KLK1 levels of these three groups were higher than that of control group(F=30.73,P<0.05).It was a significantly correlation between KLK1 level and PP in patients with type 2 diabetes mellitus(r=0.360,P=0.003).And it was not observed the significantly correlation of KLK1 level with HbA1c and Cr,respectively.Conclusion Blood level of KLK1 in DN patients is significantly higher than that in healty persons.KLK1 level elevates along with the increase of UAER and PP in patients with type 2 diabetes mellitus. The blood level of KLK1 in DN patients is not significantly correlated with blood glucose level and serum creatinine level in that.The mechanism by which the blood level of KLK1 in DN patients elevates needs further study. Exogenous KLK1 intervention may help delaying the progress of DN. |
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