| ObjectiveDiabetes often cause many complications,such as diabetic nephropathy(DN)in the clinical disease incidence rate is high,which may cause patients with end-stage renal disease(ESRD),according to the relevant data of the western advanced countries shows that: 35% of ESRD disease were caused by DN,and the proportion of domestic higher [3].Early DN urinary protein excretion in 2O-200 g/min(30-300mg/24h),in this period,the timely and effective treatment,can make stable and even reverse,avoid the development of clinical stage DN [16].Up to now,no effective treatment has been developed to reverse the pathological changes of the disease,which can cause great burden on the family,economy,psychology and social health economy.With the detection of serum markers in clinical application,it can effectively improve the detection rate of early renal injury.The purpose of this study was to investigate the value of combined detection of cystatin C,urinary albumin / creatinine ratio and retinol binding protein 4 in the diagnosis of early diabetic nephropathy.Methods118 patients with type 2 diabetes were divided into the following groups according to the urinary protein excretion rate: I group was the early renal injury group of 53 cases;the II group was the middle and advanced stage renal injury group(n = 65);in the same period,a total of 50 healthy persons were selected as control group.There was no significant difference between the three groups.The height and weight of the subjects were measured strictly according to the standard,and BMI(height / weight 2)was calculated.Application of standard cuff sphygmomanometer to measure the systolic blood pressure(SBP)and diastolic blood pressure(DBP).All the subjects were in the early morning fasting blood cystatin C determination of glycated hemoglobin and retinol binding protein 4,take the right amount of urine to detect urinary creatinine,urinary albumin,and urinary albumin / creatinine ratio corresponding to the.The testing operation is in strict accordance with the requirements of the third edition of the national clinical laboratory operation rules.Results⑴ The relationship between the occurrence and development of DN and HbA1cThe results of this study showed that the HbA1 c levels in the control group,the early kidney injury group and the advanced renal injury group were compared with each other,the difference was statistically significant.Suggesting that the incidence of diabetic nephropathy and the degree of kidney damage and blood glucose level in patients with related.⑵ The relationship between the occurrence and development of DN and BMIThe results of this study showed that the BMI levels in the control group,the early kidney injury group and the advanced renal injury group were compared with each other,the difference was statistically significant.⑶ The relationship between the occurrence and development of DN and urinary mAlb/CrThe results of this study showed that the urinary mAlb/Cr levels in the control group,the early kidney injury group and the advanced renal injury group were compared with each other,the difference was statistically significant.The positive rates of urinary mAlb/Cr in the control group,the early kidney injury group and the middle and advanced stage renal injury group were 2%,86.80% and 100%,respectively.⑷ The relationship between the occurrence and development of DN and Cys CThe results of this study showed that the Cys C levels in the control group,the early kidney injury group and the advanced renal injury group were compared with each other,the difference was statistically significant.The positive rates of serum Cys C in the control group,the early kidney injury group and the middle and advanced stage renal injury group were 0%,83.02% and 100%,respectively.The level of serum Cys C was positively correlated with the course of disease,BMI,urinary mAlb/Cr and HbA1 c,and had no significant correlation with age,sex,DBP and SBP.⑸ The relationship between the occurrence and development of DN and RBP4The results of this study showed that the urinary RBP4 levels in the control group,the early kidney injury group and the advanced renal injury group were compared with each other,the difference was statistically significant.The positive rates of serum RBP4 were 0%,79.25% and 100% in the control group,the early kidney injury group and the middle and advanced stage renal injury group,respectively.Serum RBP4 level was positively correlated with course of disease,BMI,urinary mAlb/Cr and HbA1 c,and no correlation with age,sex,DBP and SBP.⑹ Application of combined detection of three indexesThe positive rate of combined detection was 2%,98.11% and 100%,respectively,in the control group,the early kidney injury group and the middle and advanced stage renal injury group,which was significantly better than that of the single detection,and the difference was statistically significant.ConclusionsThe results of this study showed that the HbA1 c levels and the BMI levels in the control group,the early kidney injury group and the advanced renal injury group were compared with each other,the difference was statistically significant.suggesting that the incidence of diabetic nephropathy and the degree of kidney damage and blood glucose levels in patients with diabetes,obesity has accelerated the damage of kidney.Microalbuminuria is an early clinical manifestation of DN,mAlb/Cr as the evaluation index of DN is not affected by infection,fever,congestive heart failure and urinary tract infection.The results of this study showed that the level of urinary mAlb/Cr was correlated with the degree of renal injury in patients with renal disease,and the severity of the disease was also increased.The serum Cys C level and RBP4 level and duration of diabetes,blood glucose level and BMI,and these factors also are important factors affecting the development of DN,and the severity of the trend level of DN the same,at an early stage of the disease showed abnormal.Therefore,serum Cys C and RBP4 are sensitive indicators for screening DN.There are some differences between the separate detection of the monitoring indicators,combined detection in the control group,the positive rate of early renal injury group and renal injury in the group were 2%,98.11% and 100% respectively,significantly better than the single detection,there was a significant difference between the two.Therefore,the combination of mAlb/Cr,Cys and RBP can be used for the screening of early renal injury in diabetes,and provide the basis for early detection and early treatment of diabetes. |
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