ABSTRACT
Objective To explore the significance of combined detection of urinary podocalyxin (PCX), nephrin and mono-cyte chemoattractant protein-1(MCP-1) for diabetic nephropathy in newly diagnosed type 2 diabetic patients.Methods A total of 132 newly diagnosed type 2 diabetes mellitus (T2DM) patients and 36 healthy subjects were recruited .The concentrations of urinary PCX (UPCX), nephrin (UNephrin) and MCP-1(UMCP-1) were measured with enzyme-linked immunosorbent assay (ELISA), and urina-ry UAE ( UAlb) concentration was measured with turbidimetric immunoassay method .All the results were shown by dividing the urine creatinine ( UCR) concentration in the same sample .The comparisons among UAlb/UCR, UPCX/UCR, UNephrin/UCR, and UMCP-1/UCR among groups were investigated .The correlation among UAlb/UCR, UPCX/UCR, UNephrin/UCR and UMCP-1/UCR was in-vestigated in T2DM patients.The comparison among positive rate of UMCP-1/UCR, UNephrin/UCR, UPCX/UCR and UAlb/UCR was investigated in T2DM patients.Results The levels of UPCX/UCR and UMCP-1/UCR were significantly higher in diabetes melli-tus(DM) group (37.37 ±22.83 and 47.19 ±29.98, respectively) than in healthy subjects (9.59 ±2.28 and 9.98 ±3.63, respec-tively) ( P <0.05 ) .The levels of UAlb/UCR、UPCX/UCR and UMCP-1/UCR were significantly higher in diabetic nephropathy (DN) group (90.39 ±59.35, 72.11 ±58.88, and 104.82 ±82.77, respectively) than in DM group (17.50 ±9.49, 37.37 ± 22.83 , and 47.19 ±29.98 , respectively ) and in healthy subjects ( 8.93 ±3.81 , 9.59 ±2.28 , and 9.98 ±3.63 , respectively ) ( P<0.05).The level of UNephrin/UCR was significantly higher in DN group (83.60 ±61.61) than in DM group (38.74 ±35.27) ( P <0.05).The levels of UPCX/UCR, UMCP-1/UCR, and UNephrin/UCR were positively correlated with UAlb/UCR ( r =0.619, 0.568, and 0.535, respectively) ( P <0.05) in T2DM patients.The level of UPCX/UCR was positively correlated with the levels of UMCP-1/UCR and UNephrin/UCR ( r =0.799 and 0.718 , respectively ) ( P <0.05 ) .The level of UNephrin/UCR was positively correlated with the level of UMCP-1/UCR ( r =0.635 P <0.05) in T2DM patients.The positive rate of UMCP-1/UCR, UNephrin/UCR, and UPCX/UCR was significantly higher than that of UAlb/UCR(χ2 =9.818, 6.673, and 5.395, respectively, P <0.05)in T2DM patients.Conclusions The combined detection of urinary PCX , Nephrin and MCP-1 is very important for the early renal dam-age in newly diagnosed type 2 diabetic patients .
ABSTRACT
JUSTIFICATIVA E OBJETIVOS: O diabetes mellitus tipo 2) é a principal causa de doença renal terminal. O tratamento inicial da progressão da nefropatia diabética engloba o controle estrito da hiperglicemia, hiperfiltração e hipertensão. Algumas cirurgias envolvendo derivações intestinais melhoram a homeostase da glicose.Os objetivos deste estudo são avaliar os efeitos da cirurgia metabólica em pacientes com diabetes mellitus tipo 2. MÉTODOS:Estudo retrospectivo. Foram revisados prontuários de 17 pacientes diabéticos que foram submetidos à cirurgia de derivação do intestino proximal. Para comparar as variáveis foram utilizados os testes t de Student e Wilcoxon. Um valor de p<0,05 foi considerado estatisticamente significativo. RESULTADOS:A média da idade dos pacientes foi de 52,1 ± 3,5 anos e houve predomínio do sexo masculino (59%). Ocorreu redução estatisticamente significativa no peso, índice de massa corpórea, colesterol total, glicemia de jejum e hemoglobina glicada (p<0,05). Entretanto, não houve diferença estatisticamente significativa nos níveis de colesterol-HDL, colesterol-LDL, triglicerídeos, creatinina,depuração de creatinina, microalbuminúria e proteinúria de 24h (p>0,05). CONCLUSÃO: Os presentes dados sugerem que a cirurgia de derivação do intestino proximal, além da perda de peso, favorece o controle do diabetes mellitus tipo 2. Estudos com maior seguimento e número de pacientes são necessários para melhor definição do papel da cirurgia metabólica no tratamento do diabetes.
BACKGROUND AND OBJECTIVES: Type 2 diabetes mellitus is the leading cause of end-stage renal disease worldwide. Initial treatment in the progression of diabetic nephropathy includes strict control of hyperglycemia, hyperfiltration and arterial hypertension. Certain operations involving intestinal diversions improve glucose homeostasis. The objective of this study is to evaluate the effects of metabolic surgery in diabetes mellitus type 2 patients. METHODS: This is a retrospective study. We reviewed medical records of 17 diabetic patients who had undergone laparoscopic duodenal-jejunal exclusion. To compare the variables Student t and Wilcoxon tests were used. A p value < 0.05 was considered statistically significant. RESULTS: Patients mean age was 52.1 ± 3.5 years and 59% of them were male. There was a statistical significant decrease in weight, body mass index, total cholesterol, fasting glucose and glycosylated hemoglobin (p< 0.05). However, there was no statistical significant difference in levels of HDL-cholesterol, LDL-cholesterol, triglycerides, creatinine, creatinine clearance, microalbuminuria and proteinuria (p > 0.05). CONCLUSION: Our data suggest that laparoscopic duodenal-jejunal exclusion, in addition to weight loss, favors glycemic control in type 2 diabetes. Studies with longer follow-up and a larger number of patients are necessary to better define the role of metabolic surgery in the treatment of diabetes.