Key result
Urinary α2-MG, PCX, and AFU yield 0.89 AUC for diabetic nephropathy but UACR remains superior.
Why the study?
Diabetic nephropathy is a common chronic complication of type 2 diabetes mellitus, and the roles of α2-MG, PCX, AFU, RBP-4, and CysC in T2DM and DN need to be explored.
Do biomarkers such as α2-MG, PCX, AFU, RBP-4, and CysC have diagnostic value for diabetic nephropathy in patients with type 2 diabetes mellitus?
Cross-Sectional (n=203)
Do biomarkers such as α2-MG, PCX, AFU, RBP-4, and CysC have diagnostic value for diabetic nephropathy in patients with type 2 diabetes mellitus?
Effect estimate: AUC 0.89 (95% CI 0.85-0.94)
Absolute Event Rate: 0.89% vs 0.97%
p-value: p=<0.001
While novel biomarkers like α2-MG, PCX, and AFU are associated with diabetic nephropathy and have diagnostic value, UACR remains the best single diagnostic indicator.
Background: Diabetic nephropathy (DN) is one of the most common chronic complications of diabetes mellitus (DM). The changes of α2-macroglobulin (α2-MG), podocalysin (PCX), α-L-fucosidase (AFU), retinol binding protein-4 (RBP-4), cystatin C(CysC) and clinical indicators in patients with or without DN.To explore their role and significance in type 2 diabetes (T2DM) and DN.Methods: A total of 203 T2DM patients admitted to hospital from December 2018 to December 2020 were collected and divided into DN group (115 cases) and NDN group (88 cases). Urine α2-MG, PCX and AFU levels, serum RBP-4 and CysC levels were determined, and other clinical indicators were collected.Results: 1.Comparison of general data between groups: the levels of CysC, RBP-4, α2-MG/UCr,PCX/UCr and AFU/UCr in DN group were higher than those in NDN group (P<0.05). 2. Comparison of ACR stage and renal function stage of CKD: ①ACR stage: CysC, RBP-4, α2-MG/UCr, PCX/UCr, AFU/UCr increased with the increase of ACR stage(P<0.05). ② Renal function stage of CKD: CysC, RBP-4, α2-MG/UCr, PCX/UCr, AFU/UCr increased with the increase of renal function stage of CKD (P<0.05). 3. Partial correlation analysis after adjusting gender and age: CysC, RBP-4, α2-MG/UCr, PCX/UCr, AFU/UCr were positively correlated with UACR, Scr, Urea, UTP/24h, NLR, but negatively correlated with eGFR (P<0.05). 2.ROC curve: (1) Analysis of single index on DN diagnosis: AUCROC of UACR, eGFR, CysC, RBP-4, α2-MG/UCr, PCX/UCr and AFU/UCr were 0.97, 0.77, 0.80, 0.76, 0.83, 0.86, 0.79, respectively. (2) Analysis of combined indicators for DN diagnosis: AUCROC of α2-MG/UCr+PCX/UCr, α2-MG/UCr+AFU/UCr, α2-MG/UCr+PCX/UCr+AFU/UCr, α2-MG/UCr+PCX/UCr+AFU/UCr were 0.88, 0.88, 0.86, 0.89.Conclusion: 1.α2-MG, PCX and AFU are related to the occurrence and development of DN. 2. RBP-4, CysC, PCX, AFU and α2-MG have better diagnostic value,but UACR has the best diagnostic value. 3.PCX can reflect early renal damage.
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Li et al. (2022) conducted a cross-sectional in Type 2 diabetes mellitus and diabetic nephropathy (n=203). Combined urinary α2-MG, PCX, and AFU vs. UACR (standard biomarker) was evaluated on Diagnostic accuracy (AUCROC) for diabetic nephropathy (AUC 0.89, 95% CI 0.85-0.94, p=<0.001). Combined urinary levels of α2-MG, PCX, and AFU demonstrated high diagnostic value for diabetic nephropathy with an AUC of 0.89, though urinary albumin-to-creatinine ratio remained the best single predictor with an AUC of 0.97.
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