The Predictive Value Of Combined Detection Of PCX、Nephrin And MCP-1in The Early Diabetic Nephropathy Of Preliminary Diagnosis T2DM

Objective:To detect the urine concentration of PCX、Nephrin and MCP-1in preliminary diagnosis type2diabetic patients and explore the roles of them in the early prediction of diabetic nephropathy.Methods:132cases of preliminary diagnosis type2diabetic patients who were in our hospital endocrinology department from2011,May-2011,December were choosed to be studied,76cases of male,56cases of female, mean age (53±12) years old.36cases of the normal control(N) were choosed from the crowd of people who made health examination in our hospital,20cases of male,16cases of female, mean age (48±13) years old. Acorrding to2007Chinese type2diabetes prevention and treatment guidelines,using urine albumin/urine creatinine as the code of subgroup,the patients are divided into two groups:the normal albuminuria group(DM),56cases,urine albumin/urine creatinine <30mg/g,the microalbuminuria group(DN),76cases,urine albumin/urine creatinine≥30mg/g. Gathered general information on subjects, detect urine Podocalyxi(UPCX)、urine Nephrin (UNephrin)、urine MCP-1(UMCP-1)、urine albumin(UAlb) and urine creatinine(UCR).Detect fasting blood glucose(FBG)、blood uric acid(BUA)、blood urea nitrogen(BUN)、serum creatinine (CR)、total cholesterol (TC)、triglyceride (TG)、low density lipoprotein cholesterol (LDL)、high density lipoprotein cholestero (HDL),fasting C-peptide, glycosylated hemoglobin (HbAlc).Made the statistics comparison between each group of biochemical indicator,UAlb/UCR,UPCX/UCR,UNephrin/UCR,UMCP-1/UCR.Made the correlation analysis each between UAlb/UCR,UPCX/UCR,UNephrin/UCR and UMCP-1/UCR. Calculation the masccline tate of UMCP-1/UCR, UNephrin/UCR, UPCX/UCR and combined detection of the three, and made the statistics comparison with UAlb/UCR.Results: 1. compare the biochemical indicator of the three groups:Compared with N, FBG and LDL-C in DM group are higher, P is0.000and0.009,P<0.01, FBG、TC and LDL-C in DN group are higher,all the P is0.000,P<0.01. Compared with DM, LDL-C and HbA1c in DN group are higher,all the P is0.024and0.011,P<0.05.2. compare the UAlb/UCR、UPCX/UCR、UNephrin/UCR and UMCP-1/UCR of the three groups:Nephrin were undetected in N group. Compared with N, UPCX/UCR and UMCP-1/UCR in DM group are higher, all the P is0.001, P<0.01, UAlb/UCR、UPCX/UCR and UMCP-1/UCR in DN group are higher, all the P is0.000, P<0.01,the difference of UAlb/UCR between the DM and N not statistically significant,P=0.064, P>0.05. Compared with DM,UAlb/UCR、UPCX/UCR、UNephrin/UCR and UMCP-1/UCR in DN group are higher, P is0.000,0.045,0.021and0.029(P<0.05)3. The relationship of the UPCX/UCR, UNephrin/UCR and UMCP-1/UCR with the biochemical indicator:The UPCX/UCR is related with HbAlc and TC.And it become higher along with lift of HbA1c and TC(r=0.530.p=0.002; r=0.530.p=0.002).There was no statistical dependablity with the UNephrin/UCR and the biochemical indicator. The UMCP-1/UCR is related with HbA1,TC,and LDL-C.And it become higher along with lift of HbAl,TC,and LDL-C(r=0.512, P=0.004; r=0.577, P=0.001;0.398.P=0.029).4. The relationship of the UPCX/UCR, UNephrin/UCR and UMCP-1/UCR with the UAlb/UCR:The UPCX/UCR, UNephrin/UCR and UMCP-1/UCR is related with the UAlb/UCR.And the UPCX/UCR, UNephrin/UCR and UMCP-1/UCR become higher along with lift of UAlb/UCR(r==0.619,P=0.000; r=0.535,P=0.000;r=0.568,P=0.000).5. The relationship of the UPCX/UCR, UNephrin/UCR and UMCP-1/UCR:The UPCX/UCR is related with the UNephrin/UCR. And it become higher along with lift of the UNephrin/UCR (r=0.718.p=0.000). The UPCX/UCR is related with the UMCP-1/UCR. And it become higher along with lift of the UMCP-1/UC(r=0.799.p=0.000). The UNephrin/UCR is related with the UMCP-1/UCR. And it become higher along with lift of the UMCP-1/UCR(r=0.635.p=0.000).6. The masccline rate of the UPCX/UCR、UNephrin/UCR and UMCP-1/UCR of diabetic patient were76%,73%and68%,and higher then the masccline rate of the UAlb/UCR(58%)(χ2=9.818, P=0.002;χ2=6.673, P=0.01; χ2=5.395, P=0.02). The masccline rate of combined detection of them is(91%) higher then solitude detection.Conclusion:1. By the detection of urine concentration of PCX、Nephrin and UMCP-1in the early diabetic nephropathy of preliminary diagnosis T2DM,we further confirm that podocyte damage is already existence in the early diabetic nephropathy podocyte damage.2. PCX、Nephrin and UMCP-1has important effect with the occurrence and development of diabetic nephropathy.3. PCX、Nephrin and UMCP-1were all emerged before UAlb,and become higher along with lift of UAlb.4. The masccline rate of the UPCX/UCR、UNephrin/UCR and UMCP-1/UCR of type2diabetic patient were higher then the masccline rate of the UAlb, The masccline rate of combined detection of them is(91%) higher then solitude detection. Combined detection of PCX、 Nephrin and MCP-1has important clinical significance in the early diabetic nephropathy of preliminary diagnosis T2DM.