Correlation Analysis Of MAU,UTf,UIgG And Lower Extremity Vascular Disease With Diabetic Kidney Disease

Objective:This study analyzed the changes of urine microalbumin(MAU),urinary transferrin(UTf),urinary immunoglobulin G(UIgG)in different proteinuria groups and patients with lower extremity vascular disease.To evaluate the correlation between MAU,UTf,UIgG,lower extremity vascular diseases and diabetic kidney disease.Methods:During the period of April 1,2017 to November 30,2019 thirty-two months of screening,from the Department of Nephrology,Kunming First People's Hospital,a total of 241 patients with type 2 diabetes were enrolled in this study.General information of patients(include age,sex,history of hypertension,duration of diabetes,etc.),laboratory data(include MAU,UTf,UIgG,renal function,blood lipid,blood glucose,etc.),imaging data(include lower limb vascular ultrasound results)were recorded.According to Mogensen staging criteria for diabetic kidney disease and the urinary albumin creatinine ratio(ACR),they were divided into normoalbuminuria group(group A):ACR<30mg/gCr,microalbuminuria group(group B):30mg/gCr?ACR<300mg/gCr,and macroalbuminuria group(group C):ACR?300mg/gCr.And according to the results of ultrasound,they were divided into groups with lower extremity vascular disease(LEVD)group and non-lower extremity vascular disease(NLEVD)group.The clinical and laboratory datas were statistically processed in different groups.To analyze the correlation between urine microprotein and ACR.Multivariate Logistic regression analysis was used to analyze the influencing factors of lower extremity vascular disease.Analyze the relationship between MAU,UTf,UIgG,LEVD and DKDResults:1.Among the 241 patients in this study,there were 61 cases in group A,89 cases in group B,91 cases in group C.Of them,180 cases(74.69%)with proteinuria(microalbuminuria+macroalbuminuria)and 61 cases(25.31%)with normoalbuminuria.There were 2 patients without lower limb vascular ultrasound examination results,161(67.36%)patients with LEVD,78(32.64%)patients without lower limb vascular lesions.Poteinuria with LEVD had the highest proportion 132(55.23%),46(19.25%)only with proteinuria,29(12.13%)only with LEVD,neither of which was 32(13.39%).2.clinical and biochemistry data in three groupThe results showed that.the duration of diabetes,proportion combined with hypertension,systolic blood pressure(SBP),?2 microglobulin(?2-MG),ACR,?1 macroglobulin(?1-MG),blood urea nitrogen(BUN),serum creatine(SCr),UTf,MAU,UIgG in group C were higher than the other two groups.On the contrary,the estimated glomerular filtration rate(eGFR)was lower than group A and group B(P<0.05).Moreover,the proportion combined with hypertension and the levels of?2-MG,ACR,UTf,MAU and UIgG were higher in group B than those of group A(P<0.05).The level of hemoglobinAlc(HbA1c)was higher in group C than group A(P<0.05).There was no significant difference in diastolic urinary N-acetyl-?-D-glucosaminidase(NAG),blood pressure(DBP),fasting plasma glucose(FPG),uric acid(UA)and serum lipids levels between the three group(P>0.05).With the aggravation of proteinuria,the proportion of LEVD also increased(P<0.05).Of which ?2-MG,UTf,MAU,?1-MG,UIgG are positively correlated with ACR,with correlation coefficients of 0.275,0.754,0.752,0.364,0.724(P<0.001),and MAU is most strongly correlated with ACR.But eGFR was negatively correlated with ACR,with correlation coefficients of-0.391(P<0.001).3.clinica and biochemistry data in LEVD and NLEVD groupCompared with the NLEVD group,the LEVD group was older,had a longer duration of diabetes,a large proportion had hypertension and all of them reached statistical significance.(P<0.05).The gender composition of the two groups was not statistically significant(P>0.05).The results showed that the LEVD group had higher level in NAG,ACR,total cholesterol(TC),low density lipoprotein(LDL),UTf,MAU,UIgG than NLEVD group,and these attained statistical significance(P<0.05).While there were no significant difference in SBP,DBP,HbA1c,?2-MG,FPG,BUN,SCr,UA,eGFR,triglyceride(TG),low density lipoprotein(HDL),?1-MG between the two groups(P>0.05).In the univariate logistic regression,age,duration of diabetes,proportion had hypertension,UTf,MAU,UIgG,NAG,ACR,TC and LDL were the influencing factors of LEVD.When these clinical and laboratory parameters were entered in multivariate logistic regression analyses,there was an independent association between age,LDL,MAU,NAG and LEVD.But duration of diabetes,proportion had hypertension,UTf,UIgG,NAG,ACR and TC lost siginificance.Showed that age,LDL,MAU were all independent risk factors of LEVD,NAG was the protecting factor of LEVD(P<0.05).Conclusions:1.MAU,UTf,and UIgG can be used as clinical indicators for early diagnosis of diabetic kidney disease.2.With the increase of urinary albumin excretion,MAU,UTf,UIgG increased,eGFR decreased,and the proportion of lower extremity vascular disease increased.3.Patients who has higher risk of developing lower extremity vascular disease with older age,higher levels of LDL and MAU,lower level of urine NAG enzyme4.The duration of diabetes,hypertension and blood glucose control were the important factors affecting the progression of diabetic kidney disease.5.Age,course of diabetes and hypertension were the influencing factors of lower extremity vascular disease.6.This group of studies showed that gender and uric acid had no effect on the progression of type 2 diabetes to nephropathy and lower extremity vascular disease.