Correlation Between Serum SFRP5 And Adiponectin Levels And Urinary Albumin In Patients With Type 2 Diabetes Mellitus

ObjectiveDiabetes is a complex metabolic disease.according to the International Diabetes Federation,more than 415 million adults in the world suffering from diabetes,and predict the diabetes population to 2030 to 552 million.One of the most important and therapeutic complications of DM is diabetic kidney disease(DKD).DKD can occur in all forms of DM,including specific types of diabetes,such as recurrent pancreatitis induced by pancreatectomy Diabetes.Typically,30-40% of patients with type 1 DM and 10-20% of patients with type 2 DM develop DKD.Some of these patients developed endstage renal disease(ESRD).DKD late management is expensive,to the community to bring a considerable financial burden.DKD is described as the development of time with the complex structure and function of glomerular disease.Characterized by persistent albuminuria(>300 mg/24h)followed by a gradual decrease in glomerular filtration rate(GFR),leading to renal failure associated with podocyte loss,progressive glomerulosclerosis and eventual Tubulointerstitial fibrosis.It is known that the pathogenesis of DM includes the disorder of polyol pathway,the hexosamine pathways,which are responsible for excessive glycosylation of proteins,activation of protein kinase C(PKC)Growth factors,the formation and accumulation of advanced glycation end products(AGEs),cytokines and free radical accumulation.In recent years,studies suggest that chronic,low levels of inflammatory response in the occurrence and development of diabetic nephropathy play an important role.Adiponectin(ADPN)is a specific protein derived from adipocytes encoded by the adiponectin gene(ADIPOQ)located in the chromosome 3q27 region.Experimental data suggest that adiponectin may have a variety of potentialeffects,including anti-diabetic effects,anti-inflammatory effects,antiatherogenic effects.In 2010,secreted frizzled-related protein 5(SFRP5)was shown to have anti-inflammatory effects,which is another anti-inflammatory cytokine after adiponectin,which may be involved in obesity through inflammatory responses And diabetes and other metabolic diseases.At present,the research on SFRP5 is mainly focused on the fields of tumor,coronary heart disease,obesity and type 2 diabetes mellitus,and it is less studied in diabetic microangiopathy.In this study,we investigated the correlation between serum SFRP5 and adiponectin and urinary microalbumin excretion rate(UAER)in patients with type 2 diabetes mellitus by measuring the changes of serum SFRP5 and adiponectin levels in patients with type 2diabetes mellitus.To investigate whether SFRP-5 and adiponectin can be used as a predictor of diabetic nephropathy,provide the basis for early screening of DKD,provide new ideas and provide new methods for treatment.MethodsA total of 137 patients with Type 2 diabetes were enrolled in the Department of Endocrinology from December 2015 to May 2016 in Baoding First Central Hospital.The experimental group was divided into three groups according to the urinary albumin excretion rate: Normal albuminuria group(UAER<20ug/min,D1group);microalbuminuria group(20≤UAER<200ug/min,D2 group);a large amount of albuminuria group(UAER≥200ug/min,D3group).All patients with diabetes were initially diagnosed with diabetic nephropathy and no medication was used.At the same time,normal subjects were selected as controls(D0 group).Asked and recorded the age and sex of all subjects,measured their height,weight,blood pressure,fasting 10 hours after the next morning to collect fasting venous blood 5ml.The levels of Alanine aminotransferase,creatinine,Urea nitrogen,fasting blood glucose(FBG),total cholesterol(CHO),Triglyceride(TG)were measured by Hitachi automatic 7600 biochemical instrument.Determination of glycosylated hemoglobin(HbA1C)in Japan Aikelaai HA8180 instrument and its original reagent.Determination of Fasting Insulin(FINS)byElectrochemiluminescence(German Roche Electrochemiluminescence Instrument Cobas6000-E601).Stable model was used to assess the insulin resistance index(HOMA-IR)=fasting blood glucose(mmol/L)× fasting insulin(mIU/L)/22.5.Enzyme-linked immunosorbent assay(ELISA)was used to determine the levels of Secreted frizzled-related protein 5 and adiponectin(ELISA kit).The difference was <6% and the inter-assay difference was less than 10%.After taking blood 24 urine were used to determine urinary albumin excretion rate(immune scattering method,Chongqing Dr.Thai Biotechnology corporation to provide automatic specific protein analyzer).The correlation analysis between SFRP5 and ADPN and biochemical indexes was analyzed by Pearson correlation analysis.The risk factors of SFRP5 and ADPN were analyzed by multiple linear regression analysis.P<0.05 for the difference was statistically significant.Result1 There was no significant difference in gender,age,body mass index(BMI),alanine aminotransferase and aspartate aminotransferase between the four groups(P>0.05).The duration of D3 group was significantly higher than that of D1 group and D2 group(P<0.05).There was no significant difference between the other groups(P>0.05).DBP,CHO,TG,FBG and HbA1 c were statistically significant(P<0.05),and gradually increased.The difference of total bilirubin between the four groups was statistically significant(P<0.05),and gradually decreased.There was no significant difference in systolic blood pressure between D0 group and D1 group(P>0.05).There was significant difference between the other groups(P<0.05).There was no significant difference in high density lipoprotein between D2 group and D3 group(P>0.05),and there was significant difference between the other groups(P<0.05).The low density lipoprotein of D3 group was significantly higher than that of D0 group,D1 group and D2 group(P<0.05).There was no significant difference between the other groups(P>0.05).Diabetic patients with fasting insulin than the normal control group increased,the difference was statistically significant(P<0.05),the othergroups were no significant difference.There was no significant difference in insulin resistance index between D2 group and D3 group(P>0.05),and the difference between the other groups was statistically significant(P<0.05).The levels of urea nitrogen,uric acid,creatinine and glomerular filtration in DM3 group were significantly higher than those in D0 group,D1 group and D2group(P<0.05),and there was no significant difference between the other groups(P>0.05).Urine protein excretion rate in the three groups of diabetes between the difference was statistically significant(P<0.05),and showed an increasing trend.The differences between SFRP5 and ADPN were statistically significant(P<0.05).The levels of serum SFRP5 and ADPN in diabetic patients were significantly lower than those in normal controls(P<0.05).Serum levels of SFRP5 and ADPN in D2 group and D3 group were significantly higher than those in D1 group(P<0.05).Serum levels of SFRP-5and ADPN in D3 group were significantly higher than D2 group(P<0.05).(See Table 1)2 Correlation analysis of SFRP5 with related indexesIn patients with diabetes mellitus,serum SFRP5 levels were positively correlated with DBP,CHO,TG,FBG,Fins,HOMA-IR,BUN,CR,UAER,ADPN(r=0.426,0.234,0.481,0.36,0.511,0.426,0.443,0.721,0.813,P<0.05),and negatively correlated with HDL,eGFR and total bilirubin(r=-0.258,-0.237,-0.260,P <0.05).(See Table 2)In patients with diabetes mellitus,ADPN levels were positively correlated with DBP,CHO,TG,FBG,Fins,HOMA-IR,HbA1 c,BUN,CR,UAER,SFRP5(r = 0.364,0.284,0.371,0.631,0.282,0.422,0.644,0.355,0.445,0.595,0.813,P<0.05),and negatively correlated with HDL,GFR,total bilirubin(r =-0.323,-0.261,-0.182,P<0.05).(See Table 3)3 SFRP5 was used as the dependent variable Y,and DBP,CHO,TG,HDL,total bilirubin,FBG,Fins,HOMA-IR,BUN,CR,UAER,HDL and eGFR were used as independent variables.The results showed that UAER,FBG,HOMA-IR,UA,SBP and TG were independent factors of SFRP5.(See Table 4)ADPN was used as the dependent variable Y,and SBP,DBP,CHO,TG,HDL,total bilirubin,FBG,Fins,HOMA-IR,BUN,CR,UAER,HDL and eGFR were used as independent variables.The results showed that UAER,FBG,HOMA-IR and SBP were independent factors of ADPN.(See Table 5)ConclusionThe level of serum SFRP5 and adiponectin in patients with type 2diabetes mellitus increased with the increase of UAER,and the two were correlated,suggesting that the two may participate in the occurrence of diabetic nephropathy and may become the occurrence and development of diabetic nephropathy Of the new markings.UAER,FBG,HOMA-IR,UA,SBP and TG are the influencing factors of serum SFRP5 in diabetic patients,and control blood glucose,blood lipid and blood pressure may intervene in the process of chronic inflammation in patients with type 2 diabetes mellitus.