Study Of Relationship Between Serum Adipocytokine Levels And Diabetic Cardiovascular Autonomic Neuropathy,as Well As Diabetic Nephropathy

Objective In this research we detect the serum adiponcetin and leptin levels,as well,record the indicators of heart rate variability(HRV)of type 2 diabetes patients with or without diabetic nephropathy,to analyze the relationship between serum adiponectin,leptin levels and clinical metabolic indicators,and to explore the relationship between adiponectin,leptin and diabetic nephropathy,cardiovascular autonomic neuropathy.In addition,the association of DN and CAN also will be studied.Methods 128 in-patients,from the department of neuropathy of the Metabolic Disease Hospital of Tianjin Medical University between April,2013 and February,2014,were divided into three groups:simple diabetes group(DM group):UAER<30mg/24h;microalbumin group(MA group):UAER30-300mg/24h;crude protein group(CP group):UAER>300mg/24h,eGFR>30ml/min/1.732m2.According to the china guideline for type 2 diabetes about the diagnosis standard of diabetic nephropathy.49 healthy controls were enrolled in this study.Patients and controls were age and sex matched.All subjects were excluded hepatic or renal failure,severe high blood Pressure,heart dysfunction,cerebral vascular accident,acute or chronic infection,immune system diseases and pregnancy woman.All subjects were performed by 24 hours electroneuromyography,acquiring the indicators of HRV.And measuring serum levels of adiponectin and leptin.Compare the indicators of HRV and of ADPN,leptin among the different UAER groups.And Simple linear correlation were utilized to evaluate the relations between adiponectin,leptin and the indicators of HRV.Results l.The comparison of the clinical data between all the type 2 diabetes patients and normal control group found that,the BMI,WHR,DBP,TG,TC,LDL-C.AST.eGFR,FPG,HbAlc,HoMA-IR,Leptin,ADPN,the incidence of CHD and drinking alcohol are higher than the normal control group.conversely,the HDL-C,SDNN.SDANN,rMSSD,LF(norm),LF/HF decreased than NC group.The difference was statistically significant(P<0.05).The others including age,SBP,UA,ALT,FINS,HF(norm),sex,the history of hypertension,lipid metabolism.NAFLD,smoking had no statistically significant between the two groups(P>0.05)(see table 1,2).2.Pearson correlation analysis in all the subjects showed that serum ADPN concentrations Were positively correlated with age,UAER.Leptin,FBG,TC(P<0.05),while it was negatively correlated with HDL-C,eGFR(P<0.05),and had no relation with BMI.HOMA-IR,WHR,SBP,DBP,TG,LDL-C,UA,duration of DM.HbA1C(P>0.05)(See table 3).3.Pearson correlation analysis in all the subjects showed that serum leptin concentrations Were positively correlated with age,BMI,WHR,SBP,DBP,TG,TC,LDL-C,ADPN,UAER,FBG,HOMA-IR(P<0.05),while it was negatively correlated with HDL-C,eGFR(P<0.05),and had no relation with duration of UA,DM,HbAlC(P>0.05)(See table 3).4.The peason correlation analysis between all the indicators of HRV and ADPN,Leptin showed that serum ADPN concentrations were negatively correlated with SDNN,SDANN,rMSSD,LF(norm),HF(norm)(P<0.05),but it had no relation with LF/HF(P>0.05).Serum leptin concentrations were negatively correlated with SDNN,SDANN,LF(norm)(P<0.05),but it had no relation with rMSSD,HF(norm),LF/HF(P>0.05).(See table 4).5.The comparisons of the ADPN levels among the DM group,MA group,CP group,NC group showed that,the ADPN concentrations of the DM group is significantly decreased than NC group(P<0.05).but with the increase of UAER,the ADPN concentrations increased significantly(P<0.05)(see table 5,telegram 1).6.The comparisons of the leptin levels among the DM group,MA group,CP group,NC group showed that the levels of leptin of the DM group,MA group,CP group were increased than NC group,the leptin concentrations increased significantly with the increase of UAER(P<0.05)(see table 5,telegram 1).7.The comparisons of all the indicators of time-domain analysis among the DM group,MA group,CP group.NC group showed that,all the indicators of time-domain analysis had no statistically difference between the DM group and NC group,but they decreased with the increase of UAER.Furthermore,all of indicators of time-domain analysis in the CP group decreased significantly than the others.(P<0.05)(see table 6,telegram 2).8.The comparisons of all the indicators of frequency-domain analysis among the DM group,MA group.CP group.NC group showed that,on the whole,the LF(norm)decreased with the increase of UAER,the LF(norm)between CP group and MA group had no statistically difference(P<0.05),but the CP group and MA group increased significantly than NC group,DM group(P<0.05).And the HF(norm),the value of LF/HF have no statistically difference among all the groups(P<0.05).(see table 7.telegram 3)。Conclusions 1.In the early stage of type 2 diabetes mellitus,when there was no DN,the ADPN was significantly declined,but with the increase of UAER and the decreases of eGFR,the ADPN would significantly increase and this increase was significantly related to obese,insulin resistance and lipid metabolism,but when DN present,the ADPN was significantly related to the UAER and the eGFR.2.Compared with NC,the leptin of diabetes patients(include all the patients of DN)was significantly increased,and with the increase of UAER.the leptin would increase and the leptin resistance will increase significantly.This change of leptin was related to obese,insulin resistance,lipid metabolism,UAER,and the decrease of eGFR.3.The indicators of HRV decrease generally,with the increase of UAER,which indicates the progress of DN was closely related to CAN.4.The pearson correlation results of the indicators of HRV and ADPN.leptin showed:CAN might related to ADPN,Leptin.ADPN and leptin might affect the progress of CAN in some ways.5.The conclusion above indicated that there were some relationship among DN,CAN,and some adipokines(like ADPN and leptin).