Clinical Significance Of IGF-1 And PEDF In Type 2 Diabetic Nephropathy And Correspndence Analysis Of Chinese Medicine Syndrome Type And Clinical Stage In Diabetic Nephropathy

Objective:Through the observation of type 2 diabetic nephropathy patients in the in insulin-like growth factor-1 and pigment epithelium derived-factor levels, explore the relationship and clinical significance of IGF-1 and PEDF with type 2 diabetic nephropathy study whether IGF-1 and PEDF are independent risk factors for type 2 diabetic nephropathy.Seek distribution in Chinese medicine syndrome type and to provide objective evidence for the treatment with traditional Chinese and Western medicine for this disease.Methods:Collected from October 2013 to October patients met the inclusion of 90 cases, 90 patients with type 2 diabetic nephropathy were divided into three groups, group N-UAlb (14males,16females), group M-UAlb (16males, 14females), group L-UAlb (15males,15females) and 20 healthy people were selected as control group. Collecting heparin plasama of Patients, detecting serum IGF-1 and PEDF concentrations by Enzyme-Linked Immunosorbent Assay (ELISA), while fasting plasma glucose (FPG), blood lipids (TG、TC、HDL、LDL), kidney and liver funcion (Scr、UA、CYS-C、ALT、AST). Collecting the patient’s EDTA-K2 anti coagulated whole bloody glycated hemoglobin (HbAlc). While urine specimens from 24-hour urine specimens protein. Measurement of the object height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), estimated glomerular filtration rate (eGFR), and asks the duration of diabetes and other general history of the cases.Results:1、Levels of experimental groups of IGF-1 and PEDF levels are significantly higher than control group, the difference was statistically significant (p<0.05). With the increase of urinary mALB and urinary albumin excretion rate, IGF-1, PEDF levels were also significantly increased in type 2 diabetic nephropathy groups, the difference was statistically significant (p<0.05).2、Stratified by eGFR levels, IGF-1, PEDF levels associated with the degree of renal damage in type 2 diabetic nephropathy, and the more severe kidney damage, the higher levels of IGF-1 and PEDF, the difference was statistically significant (p<0.05).3、Using spearman correlation analysis with IGF-1 and other clinical detection index. LDL-C levels in the control group showed a negative correlation between the level of IGF-1 (r=-0.680. P<0.05); group N-UAlb (level I) BMI,TG and HbAlc levels in this group IGF-1 were positively correlated (r=0.401. P<0.05; r=0.426. P <0.05; r=0.417. P<0.05); group M-UAlb (level II) SBP, mALB and FPG levels in this group IGF-1 were positively correlated (r=0.355. P<0.05; r=0.417. P<0.05; r=0.446. P<0.05); group L-UAlb (level III) FPG, CYS-C, Scr levels in this group IGF-1 were positively correlated (r=0.546. P<0.05; r=0.917. P<0.05; r=0.461. P <0.05).4、Using spearman correlation analysis with PEDF and other clinical detection index. BMI, TG, TC levels in the control group showed a positively correlation between the level of PEDF (r=0.425. P<0.05; r=0.571. P<0.05; r=0.857. P<0.05); group N-UAlb (level I) FPG and HbAlc levels in this group PEDF were positively correlated (r=0.506. P<0.05; r=0.587. P<0.05); group M-UAlb (level II) mALB and FPG, BMI levels in this group PEDF were positively correlated (r=0.455. P<0.05; r=0.542. P<0.05; r=0.322. P<0.05); group L-UAlb (level Ⅲ) mALB levels in this group PEDF was positively correlated (r=0.487. P<0.05).5、Respectively, in the control group, group N-UAlb (level Ⅰ), group M-UAlb (level Ⅱ), group L-UAlb (level Ⅲ) in clinical serum IGF-1 level as the dependent variable, the experimental group of indicators relevant independent variables stepwise multivariate linear regression analysis. LDL-C into the control group, the regression equation:Y= 6.944-0.748(LDL-C); BMI, HbAlc into the group N-UAlb (level I), the regression equation:Y=7.475(BMI)+0.745(HbAlc)+43.914; SBP level, mALB level, FPG level into the group M-UAlb (level II), the regression equation: Y=1.942(FPG)+3.231(mALB)+0.255(SBP)+70.837; FPG、CYS-C into the group L-UAlb (level Ⅲ), the regression equation:Y=1.215(CYS-C)+0.771(FPG)+14.579.6、Respectively, in the control group, group N-UAlb (level I), group M-UAlb (level II), group L-UAlb (level Ⅲ) in clinical serum PEDF level as the dependent variable, the experimental group of indicators relevant independent variables stepwise multivariate linear regression analysis. TG、TC into the control group, the regression equation:Y=5.286(TG)+0.155(TC)-7.282; HbAlc, FPG into the group N-UAlb (level I), the regression equation:Y=0.737(HbAlc)+0.047(FPG)+0.737; mALB, FPG into the group M-UAlb (level II), the regression equation: Y=1.587(mALB)+1.057(FPG)+0.487; Indicators of the group L-UAlb (level Ⅲ) were not entered into the regression equation.7、ROC curve and the area under the curve (AUC) for the experimental group IGF-1 level, PEDF level and the common clinical indices of renal function: PEDF(0.9010)>mALB(0.8956)>CYS-C(0.8942)>IGF-1(0.8758)>24-hour urine specimens protein (0.8531)> UA(0.7598). When 90.5540 ng/ml IGF-1 as a diagnostic threshold for impaired renal function, the sensitivity and specificity to achieve the best, respectively(82.50%,80.00%). When 9.5430μg/ml PEDF as a diagnostic threshold for impaired renal function, the sensitivity and specificity to achieve the best, respectively(86.67%,85.00%).8、correspndence analysis of Chinese medicine syndrome type and Clinical stage, the results showed:deficiency of both qi and yin for the first (n=40), the incidence rate was 44.44%; The spleen and kidney qi deficiency (n=32), the incidence rate was 35.56%; Dryness heat due to deficiency of yin (n=12), the incidence rate was 13.33%; Tow deficiency of yin and yang (n=6), the incidence rate was 6.67%. The corresponding results of analysis showed:the distribution of Chinese medicine syndrome type was related with Clinical stage in the type 2 diabetic nephropathy (x2=17.100, p<0.001)Conclusion:1、IGF-1, PEDF levels of each experimantal group were significantly higher than control groups (p<0.05). Prompted IGF-1 and PEDF elevated levels of type 2 diabetic nephropathy have some clinical value.2、Type 2 diabetic nephropathy in serum IGF-1 level, PEDF level and type 2 diabetic kidney injury associated with type 2 diabetic nephropathy when more severe impairment, the higher level of IGF-1 and PEDF.3、As the disease progresses in different periods of type 2 diabetic nephropathy, there is a certain correlation with IGF-1, PEDF and glucose metabolism, lipid metabolism and common clinical indicator of kidney injury.4、IGF-1, PEDF has a certain value of the underlying value in diagnosis of nephropathy in type 2 diabetes. Therefore, IGF-1 and PEDF can be used as a new serum marker in the early diagnosis of disease assessment, has good prospects for clinical application to predict disease outcome.5、The distribution of Chinese medicine syndrome type was related with Clinical stage in the type 2 diabetic nephropathy. Seek distribution in Chinese medicine syndrome type and to provide objective evidence for the treatment with traditional Chinese and Western medicine for this disease.