The Relationship Of Serum Homocysteine And Cystatin C To Diabetic Nephropathy

Objective:To investigate the relationship of serum Homocysteine andCystatin C to Type two Diabetic Nephropathy,to study whether serumHomocysteine and Cystatin C can be the sensitive index of the early diagnosisof Type two Diabetic Nephropathy. To provide provide practice basis for earlyclinical diagnosis.Methods:100patients of T2DM were choosed as a subject of the studywho are in the endocrine department from The Third clinical medical school ofThe Jilin University from May.2013to Jan.2014, and who have be diagnosedas diabetic according to the publication of’Diabetes diagnosis andclassification standard′of WHO in1999. Male:56cases, female:44cases, age:from25to80，average age:（54.15±12.24）.Normal control group:20healthycases, male:10cases, female:10cases, age from40to70, average age（55.42±9.14）.According to Mogenson staging,the DM patients aredividedinto three groups,(1)Simple diabetes group (A):UAER<20ug/min,32cases:Male:18cases,female:14cases.(2)Early diabetic nephropathy Group (B):UAER reaches20~200ug/min,40cases:Male:22cases, female:18cases.(3)Clinical diabetic nephropathy group(C):UAER≥300ug／min。28cases:Male:16cases, female:12cases.The people from Normal control group are definedto the healthy subjects by the physical examination, no diabetes mellitus, noserious liver, kidney or other organs diseases, no hypertensionor otherendocrine system disease.All cases since morning on an empty stomach todetermine weight, height, waist circumference, blood pressure, calculatingbody mass index (BMI),and the nurse take their Venous blood from elbow onan empty stomach, to determine hemoglobinA1c (HbA1c)、blood biochemistry and Cystatin C and homocysteine。All cases to return24hours urine,record thetotal amount of urine and determine urine Microalbuminuria,and to calculatethe Glomerular ffilteration rate.To analyse and compare the relationship of Hcy,CysC and various indicators of T2DM group and normal control group.Result:(1) There is no significant difference in Age, gender ratio, weight,waist circumference, diastolic blood pressure, triglycerides between theobservation groups and control group, there is no statistical significance（P>0.05）.As the extension of the disease duration, and exacerbation of thedisease,UAER、SBP and HbA1c increase significantly (P＜0.05),the levelof Total cholesterol of the observation groups raise significantly compare withcontrol group(P＜0.05).(2)The level of Total cholesterol of the observationgroups raise significantly compare with control group(P＜0.05).The level ofHcy of group A raise compare with control group(P＜0.05),there is nosignificant difference between the index of Group A and control group, there isno statistical significance（P>0.05），the level of Hcy and Cys C of group Braise significantly compare with group A and control group(P＜0.05), and ingroup B the change of Hcy and Cys C is more significant than Scr andBUN,the difference have statistical significance(P＜0.05).There is nosignificant change of Scr and BUN in group B compare with group A andcontrol group（P>0.05）, so there is no statistical significance，every index hassignificance in the group C compare with the group A, group B and controlgroup, there is statistical significance (P＜0.05)。Observation group ofGlomerular ffilteration rate showed a trend of gradual decline(P＜0.05).(3)Hcy positively related to disease duration,UAER、Scr、BUN、HbAlc1andSBp, and negatively correlated with GFR. Cys C positively related to Hcy、disease duration, UAER、 Scr、 BUN、 HbAlc1and SBp, and negativelycorrelated with GFR（.4）serum CysC level was significantely influenced by theUAER and glycated hemoglobin, the Hcy level was significantely influencedby the UAER，glycated hemoglobin and disease duration。(5)The positive rate of CysC in every group respectively are0%、15.6%、55%、82.1%.The positiverate of Hcy in every group respectively are5%、18.8%、52.5%、75%.Thepositive rate of Scr in every group respectively are0%、3.1%、12.5%、71.4%,The positive rate of Bun in every group respectively are5%、9.4%、17.5%、78.6%.Early diabetic nephropathy patients with CysC and Hcyhad ahigher positive detection rate,they are significantly higher than the positive rateof Scr and Bun.Conclusion:CysC can reflect the change of GFR more accurately thanScr,making it ideal mark of GRF,which is of great help to the early kidneydamage diagnosis of DN.Hcy is a dangerous factor which Diabetic patientshave emerged.It can be used as a efficient index to detect DN.Diabeticpatients regularly detecting CysC and Hcy is very significant to the earlydiagnosis of the damage of Glomerular filtration function and decreasing thedisease.