Cohort Study Of Urinary Protein Sensitivity Index(Glycorenal Index) In Susceptibility To Diabetic Nephropathy

Objective:In recent years,urine glucose and urine microalbumin detection have been gradually applied in the clinical diagnosis of diabetic nephropathy（DKD）.Because the treatment of diabetic nephropathy still has some limitations,early detection and prevention of diabetic nephropathy is a major problem that we need to solve.We examined whether glycorenal index（GCRI）（defined as the ratio of urinary protein to urinary glucose）was a predictor of diabetic nephropathy.Methods:Subjects were diabetes patients who were hospitalized in the First Affiliated Hospital of Wannan Medical College for 2 to 4 times from October,2003 to December,2020.Among them,361 patients were hospitalized for 2 times,244 patients for 3 times and 167 patients for 4 times.Basic data of patients were collected,including admission number,name,gender,age,gender,course of diabetes,systolic blood pressure,diastolic blood pressure,and laboratory indicators of patients were recorded,including urine glucose,urine protein,urea,creatinine and other indicators.According to whether urine glucose and urine protein were positive at the first hospitalization,they were divided into 4 groups(positive urine glucose and urine protein;Positive for urine glucose and negative for urine protein;Negative urine sugar and positive urine protein;According to the relevant statistical analysis of the data of the four groups,to explore whether the glycorenal index can be used as a predictor of diabetic nephropathy.Results:1.By comparing the baseline data of the four groups,it was found that there were significant differences in urinary protein,urinary glucose,urinary microalbumin,urinary albumin excretion rate and 24h urinary protein among the four groups（P<0.05）.The comparison of the positive group and negative group showed that:a,the positive group:urine protein,urine sugar,urine microalbumin,urine albumin excretion rate,24h urine protein and other positive urine protein group were higher than the negative group,there was a significant difference between the two groups（P<0.05）;B,glycosuria negative groups:urine protein,urine sugar,urinary albumin excretion rate,urine trace albumin urine sugar negatie urine protein positive above glycosuria negatie urine protein negative group,there were significant differences between two groups（P<0.05）.2.The positive rate of urinary protein in the four groups at later stage:According to the results of urine glucose and urine protein,they were divided into4 groups,and the last occurrence of urine protein in each group was counted（i.e.the late stage）.In the U^P-/G-group,there were 280 cases,and 42 cases（15%）were positive for late urine protein.There were 196 cases in U^P-/^G+group,and 36 cases（18.37%）were positive for late urine protein.There were 32 cases in U^P+/G-group,and 20 cases（62.50%）were positive for late urine protein.There were 44 cases in U^P+/G+group,and32 cases（72.73%）were positive for late urine protein.The difference between the four groups was statistically significant.Further analysis showed that the positive rate of urinary protein in the late stage of the former group was higher than that of the latter in the positive and negative groups,the U^P+/G+and U^P-/G+groups,and the U^P+/G-and U^P-/G-groups.3.Correlation analysis of the occurrence of urine sugar and urine protein:Spearman correlation test was used to find that:Positive urine glucose,urea,blood uric acid,fasting blood glucose,cholesterol,triglyceride,glycation,fasting C-peptide,2h postprandial C-peptide,2h postprandial blood glucose,disease course,systolic blood pressure and diastolic blood pressure were all important related factors for the occurrence of urinary protein,and the difference was statistically significant（P<0.05）.Urea,fasting blood glucose,cholesterol,triglyceride,glycation,fasting C-peptide,2h postprandial C-peptide,2h postprandial blood glucose,24h urinary protein,disease course and diastolic blood pressure were all important related factors for the occurrence of urine glucose,and the difference was statistically significant（P<0.05）.4.In order to further explore the correlation between different glucorenal index and the occurrence of urinary protein,we combined the two groups of positive glucorenal index,and divided the glucorenal index according to x<0.1,0.1≤x<0.2,0.2≤x<0.5,0.5≤x<1,1≤x,respectively(the definition of glucorenal index:Refers to the urine protein sensitivity index（the ratio of urine protein value to urine glucose value,as shown in the conversion table below）,which was divided into five corresponding risk stratifications:low,medium,medium,high,and extremely high.The results showed that with the increase of the glycokidney index and the risk of stratification,the positive rate of urine protein in the later period was higher.The trend chi-square test showed that the upward trend was statistically significant.The urine sugar was stratified according to the sugar kidney index,and the correlation analysis of urine sugar and urine protein showed that the sugar kidney index was between 0.1∽1,and there was a correlation between urine sugar and urine protein,the difference was statistically significant（P<0.05）,and there was no significant correlation in the low and very high stratification（P>0.05）.5.Comparison of the incidence of urinary protein among different genders:there were 316 males,82 males and 236 females,and 48 males with positive urinary protein in the late stage.Chi-square test showed P>0.05,showing no statistical significance.Therefore,it could be considered that the incidence of positive urinary protein in the late stage of diabetic patients was independent of gender.6.The urine protein was positive in patients with different age stratificationAmong the patients≤30 years old,6 cases（13.6%）developed positive urinary protein in the late stage.Twenty-one patients（22.3%）aged between 30 and 45 years（including the latter）were positive for urinary protein.49 patients（22.2%）aged between 45 and 60 years were found to be positive for urinary protein.46 cases（26.4%）were found to be positive for urinary protein between 60 and 75 years old.Eight patients（42.1%）were positive for urinary protein at 75 years of age.One-way analysis of variance test,P>0.05,the difference was not statistically significant.7.Patients with different systolic blood pressure stratification had positive urine protein at later stageAmong the patients with SBP≤120mm Hg,8 cases（5.7%）had positive urinary protein in the late stage.In the patients with SBP of 120-140mm Hg,there were 38 cases（14.2%）with positive urinary protein in the late stage.Among the patients with SBP of140-160mm Hg,75 cases（61.5%）were positive for urinary protein in the late stage.In the patients with systolic blood pressure>160mm Hg,there were 9 cases（40.9%）with positive urinary protein in the late stage.The R*C table chi-square test was used,and the difference was statistically significant（P<0.05）,indicating that the positive rate of urinary protein was different in the four groups with different systolic blood pressure.Further analysis:84 patients（58%）with systolic blood pressure≥140mm Hg had positive urinary protein in the late stage;In the patients with systolic blood pressure<140mm Hg,46 patients（11.27%）had positive urinary protein in the late stage.Chi-square test was used,P<0.05,and the difference was statistically significant.The positive rate of urinary protein in diabetic patients with hypertension was higher than that without hypertension.8.Patients with different diastolic blood pressure stratification had positive urine protein at later stageAmong the patients with diastolic blood pressure≤80mm Hg,11 cases（17.2%）had positive urinary protein in the late stage.Among the patients with diastolic blood pressure of 80-90mm Hg,83 cases（21.4%）were positive for urinary protein in the late stage.In the patients with diastolic blood pressure of 90-100mm Hg,24 patients（35.3%）had positive urinary protein in the late stage.In the patients with diastolic blood pressure>100 mm Hg,12 patients（37.5%）had positive urinary protein in the late stage.The chi-square test of R*C table was used,and the difference was statistically significant（P<0.05）,indicating that the positive rate of urinary protein was different in the four groups with different diastolic blood pressure.Further analysis:In patients with diastolic blood pressure≥90mm Hg,36 cases（36%）had positive urinary protein in the late stage;In the patients with diastolic blood pressure<90mm Hg,94 cases（20.80%）had positive urinary protein in the late stage.Chi-square test was used,P<0.05,and the difference was statistically significant,suggesting that the positive rate of urinary protein in diabetic patients with hypertension was higher than that without hypertension.9.The positive status of urinary protein after stratification of different disease course（years）Of the patients with a course of disease≤5 years,38（18.4%）had positive urine protein in the late stage,40（21.7%）had positive urine protein in the 5-10 years,18（22%）had positive urine protein in the 10-15 years,and 34（42.5%）had positive urine protein in the 15-year course of disease.By R*C table chi-square test,P<0.05,the difference was statistically significant,indicating that the positive rate of late urine protein was different in diabetic patients with different course of disease.Conclusions:1.The incidence of positive urinary protein in late diabetic patients was not related to gender and age,but was closely related to systolic blood pressure,diastolic blood pressure,course of disease,blood glucose and other factors,especially the glycorenal index.2.With the increase of the risk of glycorenal index and stratification,the rate of positive urine protein in the late stage is higher and higher;3.There is a conditional correlation between the occurrence of urine protein and urine glucose in patients with DKD（clinical susceptibility）.The urine protein sensitivity index（glycokidney index）can be used as a prediction index of DKD susceptibility to guide the prevention and treatment of clinical DKD.