Expression And Clinical Significance Of Proprotein Convertase Subtilisin/Kexin Type 9 In Patients With Type 2 Diabetic Kidney Disease

Objective: Diabetic kidney disease(DKD)is one of the main chronic complications of diabetes and the main cause of end-stage renal disease.The pathogenesis of DKD is complex,and dyslipidemia plays an important role in the development of DKD.Proprotein convertase subtilisin/kexin type 9(PCSK9)is a serine protease associated with lipid metabolism,inflammation,and apoptosis.In this study,serum PCSK9 level was detected in T2 DM patients with or without diabetic kidney disease.The correlation between PCSK9 and blood glucose,blood lipid,renal function and other indicators was analyzed.The potential relationship between PCSK9 and DKD was further explored as well as its clinical significance.Methods: A total of 135 patients who were hospitalized patients of endocrinology department and nephrology department of Hebei General Hospital from March 2018 to December 2018(76 males and 59 females)were included in the study.They were divided into T2 DM control group without diabetic kidney disease(CON,68 subjects)and diabetic kidney disease group(DKD,67 subjects).General data were collected such as medical history,medication history and past history.Fasting plasma glucose(FBG),Hemoglobin a1c(Hb A1c),blood lipid,Serum creatinine(SCr),Blood urea nitrogen(BUN),Serum uric acid(SUA),Estimated glomerular filtration rate(e GFR),Total bile acid(TBA)and other relevant indicators were detected.Serum PCSK9 levels were detected by enzymatically linked immunosorbent assay.The differences of the above indicators in the two groups were compared and their correlation was analyzed.SPSS 26.0 software was used for statistical analysis.Results:1.Comparison of general clinical data between the two groupsThe two groups were matched in age and sex.Body mass index(BMI),FBG,Hb A1 c,TBA,SUA,Total cholesterol(TC),triglycerides(TG),Low-density lipoprotein cholesterol(LDL-C)and High-density lipoprotein cholesterol(HDL-C)showed no statistically significant difference between the two groups.Compared with the control group,the course of disease was longer,SCr,BUN were increased in diabetic kidney disease group,and e GFR was decreased in diabetic kidney disease group.There were significant differences between two groups.(P<0.05).2.The difference of serum PCSK9 level between the two groupsThe level of serum PCSK9 in diabetic kidney disease group was significantly increased than the Control group(P<0.05).3.The correlation between serum PCSK9 level and other indicatorsSerum PCSK9 level was positively associated with age(r=0.196,P=0.023),and Hb A1c(r=0.195,P=0.023),negatively associated with e GFR(r=-0.971,P=0.023).But it was not significantly correlated with BMI,FBG,TBA,TC,TG,HDL-C,LDL-C,SCr,BUN,SUA.4.The influence factors of e GFRMultiple linear stepwise regression analysis showed that PCSK9 and Hb A1 c were the main influencing factors of e GFR.Conclusion:1.The level of serum PCSK9 in diabetic kidney disease group is significantly increased than the Control group.It suggests that serum PCSK9 may be involved in the occurrence and development of type 2 diabetic kidney disease.2.The level of serum PCSK9 in T2 DM patients is positively correlated with age and Hb A1 c,and negatively correlated with e GFR.PCSK9 and Hb A1 c are the main influencing factors of e GFR.