Abstract:Objective To investigate the effect of serum Glypican-4 factor on diabetic kidney disease (DKD) in obese patients with type 2 diabetic mellitus. Methods A total of 128 obese patients with type 2 diabetes mellitus diagnosed and treated in Fifth Affiliated Hospital of Xinjiang Medical University from September 2020 to April 2021 were selected. According to the Chinese Clinical Guidelines for the Prevention and Treatment of Diabetic Kidney Disease, the patients were divided into diabetes group and DKD group. The influence factor of DKD in obese patients with type 2 diabetes mellitus were analyzed; Spearman correlation coefficient was used to analyze the correlation between related indexes and urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR); the value of Glypican-4 factor in the diagnosis of DKD in obese patients with type 2 diabetes mellitus was determined by receiver operating characteristic curve. Results There were significant differences in hypertension, course of disease, urinary microalbumin, eGFR, UACR, serum creatinine, triglyceride (TG), glycosylated hemoglobin (HBA1c), fasting blood glucose (FBG), 2h postprandial blood glucose (2hPG), and Glypican-4 between two groups (P < 0.05). Glypican-4, FBG, 2hPG, course of disease, hypertension, and TG were the influencing factors of DKD in obese patients with type 2 diabetes mellitus (OR > 1, P < 0.05). Glypican-4, HBA1c, FBG, 2hPG, course of disease, hypertension, and TG were positively correlated with UACR (r > 0, P < 0.05), and negatively correlated with eGFR (r < 0, P < 0.05). The cut-off value of Glypican-4 for DKD in obese patients with type 2 diabetes mellitus was 0.76 ng/ml, the area under the curve was 0.693, the sensitivity was 69.0%, and the specificity was 65.7%. Conclusion There is a correlation between serum Glypican-4 and DKD in obese patients with type 2 diabetes mellitus. Glypican-4 is a risk factor for DKD and has certain value in the diagnosis of DKD.
[1] Saeedi P,Petersohn I,Salpea P,et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045:Results from the International Diabetes Federation Diabetes Atlas,9(th)edition [J]. Diabetes Res Clin Pract,2019,157(5):107-115.
[2] Ruiz-Ortega M,Rayego-Mateos S,Lamas S,et al. Targeting the progression of chronic kidney disease [J]. Nat Rev Nephrol,2020,16(5):269-288.
[3] Bae J,Won YJ,Lee BW. Non-Albumin Proteinuria (NAP) as a Complementary Marker for Diabetic Kidney Disease(DKD)[J]. Life(Basel,Switzerland),2021,11(3):64-69.
[4] Thethi TK,Batuman V. Challenging the conventional wisdom on diabetic nephropathy:Is microalbuminuria the earliest event? [J]. J Diabetes Complications,2019,33(3):191-192.
[5] Kravets I,Mallipattu SK. The Role of Podocytes and Podocyte-Associated Biomarkers in Diagnosis and Treatment of Diabetic Kidney Disease [J]. J Endocr Soc,2020, 4(4): bvaa029.
[6] Zhang H,Hu W,Zhang G. Circulating asprosin levels are increased in patients with type 2 diabetes and associated with early-stage diabetic kidney disease [J]. Int Urol Nephrol,2020,52(8):1517-1522.
[7] Ye X,Luo T,Wang K,et al. Circulating TNF receptors 1 and 2 predict progression of diabetic kidney disease:A meta-analysis [J]. Diabetes Metab Res Rev,2019,35(8):3195-3199.
[8] Ussar S,Bezy O,Blüher M,et al. Glypican-4 enhances insulin signaling via interaction with the insulin receptor and serves as a novel adipokine [J]. Diabetes,2012,61(9):2289-2298.
[9] Tamori Y,Kasuga M. Glypican-4 is a new comer of adipokines working as insulin sensitizer [J]. J Diabetes Investig,2013,4(3):250-251.
[10] Zhu HJ,Pan H,Cui Y,et al. The changes of serum glypican4 in obese patients with different glucose metabolism status [J]. J Clin Endocrinol Metab,2014,99(12):2697-2701.
[11] Cha JJ,Min HS,Kim K,et al. Long-term study of the association of adipokines and glucose variability with diabetic complications [J]. Korean J Intern Med,2018,33(2):367-382.
[12] 中华医学会糖尿病学分会微血管并发症学组.中国糖尿病肾脏疾病防治临床指南[J].中华糖尿病杂志,2019,11(1):15-28.
[13] Filmus J,Ohlrogge AW,Malanda B. Global,regional,and national life expectancy,all-cause mortality,and cause-specific mortality for 249 causes of death,1980-2015:a systematic analysis for the Global Burden of Disease Study 2015 [J]. Lancet(London,England),2016,388(10053):1459-1544.
[14] Umanath K,Lewis JB. Update on Diabetic Nephropathy:Core Curriculum 2018 [J]. Am J Kidney Dis,2018,71(6):884-895.
[15] Rodriguez F,Lee DJ,Gad SS,et al. Real-World Diagnosis and Treatment of Diabetic Kidney Disease [J]. Adv ther,2021,38(8):4425-4441.
[16] Espinel E,Agraz I,Ibernon M,et al. Renal Biopsy in Type 2 Diabetic Patients [J]. J Clin Med,2015,4(5):998-1009.
[17] Gurley SB,Ghosh S,Johnson SA,et al. Inflammation and Immunity Pathways Regulate Genetic Susceptibility to Diabetic Nephropathy [J]. Diabetes,2018,67(10):2096-2106.
[18] Hu J,Yang S,Wang Y,et al. Serum bisphenol A and progression of type 2 diabetic nephropathy:a 6-year prospective study [J]. Acta Diabetol,2015,52(6):1135-1141.
[19] Alicic RZ,Rooney MT,Tuttle KR. Diabetic Kidney Disease:Challenges,Progress,and Possibilities [J]. Clin J Am Soc Nephrol,2017,12(12):2032-2045.
[20] Hu J,Yang S,Zhang A,et al. Abdominal Obesity Is More Closely Associated With Diabetic Kidney Disease Than General Obesity [J]. Diabetes Care,2016,39(10):e179-e180.
[21] 刘竞争,陈燕,黄泽玉,等.随机尿微量白蛋白_肌酐比值的半定量试纸条法的临床评价[J].标记免疫分析与临床,2018,25(4):569-573.
[22] Wang H,Xu W,Huang C,et al. High ACR level is a strong risk factor for renal tubular impairment in patients with type 2 diabetes:A longitudinal observational study [J]. Diabetes Res Clin Pract,2020,165(22):108-122.
[23] Zhang K,Zhu H,Wang L,et al. Serum glypican4 and glycosylphosphatidylinositol-specific phospholipase D levels are associated with adipose tissue insulin resistance in obese subjects with different glucose metabolism status [J]. J Endocrinol Invest,2021,44(4):781-790.
[24] Qin W,Liang YZ,Qin BY,et al. The Clinical Significance of Glycoprotein Phospholipase D Levels in Distinguishing Early Stage Latent Autoimmune Diabetes in Adults and Type 2 Diabetes [J]. PLoS One,2016,11(6):156-169.
[25] Lu Z,Li Y,Song J. Characterization and Treatment of Inflammation and Insulin Resistance in Obese Adipose Tissue [J]. Diabetes Metab Syndr Obes,2020,13(5):3449-3460.