Correlation Between Serum PCSK9 Level And Renal Injury In Patients With Type 2 Diabetes Mellitus

Objective:Detection of serum Proprotein Convertase Subtilisin/Kexin Type 9(PCSK9)levels in patients with Type 2 Diabetes Mellitus(T2DM)to investigate the correlation between PCSK9 and renal injury in T2DM patients and its influencing factors.Methods:A total of 145 T2DM patients hospitalized in Third Xiangya Hospital of Central South University from June 2019 to January 2020 were recruited.Patients were divided into three groups according to Urine albumin/Urine creatinine ratio(UACR)level:normoalbuminuria group(Normo group,UACR<30mg/g),microalbuminuria group(Micro group,30mg/g≤UACR<300mg/g),macroalbuminuria group(Macro group,UACR≥300mg/g).At the same time,patients were divided into two groups according to estimated Glomerular Filtration Rate(e GFR)level:e GFR≥60m L/min/1.73m~2 group and e GFR<60m L/min/1.73m~2 group.According to levels of serum PCSK9,patients were divided to three groups:low PCSK9 group(PCSK9<138.99ng/m L),PCSK9 level group(138.99≤PCSK9<226.26ng/m L)and high PCSK9 level group(PCSK9≥226.26ng/m L).General information and biochemical parameters of the enrolled subjects were collected.Levels of Urine retinol binding protein/Urine creatinine ratio(URCR),Urineα1-microglobulin/Urine creatinine ratio(UαCR),Urineβ2-microglobulin/Urine creatinine ratio(UβCR)and UACR was determined by immunoturbidimetry.The serum PCSK9 level was determined by Elisa.Results:1.The levels of serum PCSK9 in Normo,Micro and Macro groups were 139.20(105.09-205.12)ng/m L,157.95(117.85-236.70)ng/m L and 252.83(171.95-422.46)ng/m L,respectively.Levels of serum PCSK9 in Macro group was significantly higher than that in Normo group and Micro group,and the difference was statistically significant(P<0.01).The levels of serum PCSK9 in e GFR≥60m L/min/1.73m~2 group and e GFR<60m L/min/1.73m~2 group were 169.10(117.07-269.32)ng/m L and 207.38(141.63-375.89)ng/m L,respectively,with statistical significance(P=0.018).2.Univariate correlation analysis showed that UACR was positively correlated with PCSK9,while e GFR was negatively correlated with PCSK9.Logistic regression analysis showed that PCSK9 was an independent risk factor for albuminuria and renal insufficiency in T2DM patients.For each increase of 10 PCSK9 units,the risk of albuminuria increased by 4.9%(OR value 1.049,P=0.029),and the risk of renal insufficiency increased by 3.7%(OR value 1.037,P=0.034).ROC curve showed that PCSK9 level of 170.53ng/m L and 337.26ng/m L had best diagnostic value for albuminuria(UACR>30 mg/g)and renal insufficiency(e GFR<60m L/min/1.73m~2)in T2DM patients.3.The Systolic Blood Pressure(SBP),URCR,UαCR and UACR levels were higher in patients with high serum PCSK9 level.Univariate correlation analysis showed that PCSK9 was positively correlated with SBP,Triglycerides(TG),URCR,UαCR and UACR,and negatively correlated with e GFR(P<0.05).Linear regression analysis showed that UACR was an independent influencing factor of serum PCSK9 level in T2DM patients.Conclusion:Serum PCSK9 level is closely related to urinary albumin excretion,renal tubular injury and e GFR in T2DM patients,and is an independent risk factor for albuminuria and renal insufficiency in T2DM patients.