PDF(Pubmed)
Abstract：
Introduction The pathogenesis of diabetic nephropathy highlights the progression of inflammation and fibrosis from tubular to glomerular damage during the early stages of kidney involvement in diabetic individuals. As urine albumin serves as a marker for glomerular function, its detection indicates a stage of diabetic nephropathy where the glomerulus is already compromised. Consequently, relying solely on urine albumin for diagnosis becomes questionable. In our pursuit of identifying innovative biomarkers for the early detection of diabetic nephropathy, this study was crafted to explore the relationship between chemokines, omentin-1, interleukin-6, and microalbuminuria. Materials and methods Our study cohort comprised 116 patients diagnosed with diabetes mellitus. In our study, participants were stratified into two groups based on their urine albumin levels: Group 1, characterized by urine albumin creatinine ratio <30 mg/gm and estimated glomerular filtration rate >90 ml/min, and Group 2, with urine albumin creatinine ratio ≥30 mg/gm and <300 mg/gm, and estimated glomerular filtration rate >60 ml/min and <90 ml/min. Serum creatinine, glycated hemoglobin (HbA1c), fasting blood sugar and post-prandial blood sugar, lipid profile, total protein, albumin, fasting insulin, omentin-1, and interleukin-6 were estimated. Result There was a significant difference in the medians of serum urea, creatinine, omentin-1, interleukin-6, urine albumin creatinine ratio, and estimated glomerular filtration rate levels in the two groups. There was no difference in fasting blood sugar, post-prandial blood sugar, HbA1c, serum lipids, fasting insulin, and homeostatic model assessment for insulin resistance. The receiver operating characteristic curve plotted for the newer biomarkers of diabetic nephropathy showed that there was a significant diagnostic utility in diabetic nephropathy detection of serum omentin (p=0.000), interleukin-6 (p=0.002), and interleukin-6: omentin-1 ratio (p=0.000), which correlated well with the routine test that is urine microalbumin estimation. Risk assessment demonstrated that type 2 diabetes mellitus patients with an interleukin-6: omentin-1 ratio ≥0.26 had significantly higher odds, with an odds ratio of 3.97, for developing diabetic nephropathy, which was statistically significant. Conversely, a ratio of ≤0.26 was associated with kidney protection among patients with type 2 diabetes mellitus. Conclusion Our findings revealed decreased levels of omentin-1 and increased levels of interleukin-6 in the group with diabetic nephropathy compared to those without diabetic nephropathy among patients with type 2 diabetes mellitus. Interleukin-6: omentin-1 ratio of ≤0.26 was associated with kidney protection among patients with type 2 diabetes mellitus. Based on the results obtained from this study, we propose that measuring the serum interleukin-6: omentin-1 ratio in patients with type 2 diabetes mellitus may assist in identifying the early stages of diabetic nephropathy before the onset of microalbuminuria. Timely intervention in these patients predisposed to diabetic nephropathy can aid in better treatment outcomes in type 2 diabetes mellitus.
摘要：
引言糖尿病肾病的发病机制突出了在糖尿病个体肾脏受累的早期阶段炎症和纤维化从肾小管损伤到肾小球损伤的进展。由于尿白蛋白可作为肾小球功能的标志物，它的检测表明肾小球已经受损的糖尿病肾病阶段。因此,单纯依靠尿白蛋白进行诊断就成问题了.在我们寻求识别用于糖尿病肾病早期检测的创新生物标志物的过程中，本研究旨在探索趋化因子之间的关系，网膜素-1、白细胞介素-6和微量白蛋白尿。材料和方法我们的研究队列包括116例诊断为糖尿病的患者。在我们的研究中,参与者根据他们的尿白蛋白水平分为两组：第1组，其特征是尿白蛋白肌酐比率<30mg/gm和估计的肾小球滤过率>90ml/min，和第2组，尿白蛋白肌酐比率≥30mg/gm和<300mg/gm，和估计肾小球滤过率>60ml/min和<90ml/min。血清肌酐,糖化血红蛋白（HbA1c），空腹血糖和餐后血糖，血脂谱,总蛋白质，白蛋白,空腹胰岛素，估计了网膜素-1和白细胞介素-6。结果血清尿素的中位数差异有统计学意义,肌酐,网膜素-1，白细胞介素-6，尿白蛋白肌酐比，并估计两组的肾小球滤过率水平。空腹血糖没有差异，餐后血糖,HbA1c,血脂，空腹胰岛素，和胰岛素抵抗的稳态模型评估。为糖尿病肾病的较新的生物标志物绘制的受试者工作特征曲线表明，在糖尿病肾病的血清网膜素检测中具有显着的诊断实用性（p=0.000），白细胞介素-6（p=0.002），和白细胞介素-6：网膜素-1的比例（p=0.000），这与尿微量白蛋白评估的常规测试密切相关。风险评估表明，白细胞介素-6：网膜素-1比值≥0.26的2型糖尿病患者的几率明显更高，患糖尿病肾病的比值比为3.97，具有统计学意义。相反，在2型糖尿病患者中,比值≤0.26与肾脏保护相关.结论我们的发现表明，在2型糖尿病患者中，与没有糖尿病肾病的患者相比，糖尿病肾病组的网膜素-1水平降低，白细胞介素-6水平升高。白细胞介素-6：网膜素-1比值≤0.26与2型糖尿病患者的肾脏保护相关。根据这项研究获得的结果，我们建议,在2型糖尿病患者中测定血清白细胞介素-6:网膜素-1的比值,可能有助于在微量白蛋白尿发病前识别糖尿病肾病的早期阶段.对这些易患糖尿病肾病的患者进行及时干预可以帮助改善2型糖尿病的治疗效果。
