Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jun 15, 2023; 14(6): 883-891
Published online Jun 15, 2023. doi: 10.4239/wjd.v14.i6.883
Application of urinary N-acetyl-β-D-glucosaminidase combined with serum retinol-binding protein in early detection of diabetic nephropathy
Zhi-Hao Lin, Sheng-Feng Dai, Jian-Nan Zhao, Yue Jiang
Zhi-Hao Lin, Sheng-Feng Dai, Department of Endocrinology, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine, Wenzhou 325000, Zhejiang Province, China
Jian-Nan Zhao, Department of Endocrinology, Yongjia Hospital of Traditional Chinese Medicine, Wenzhou 325000, Zhejiang Province, China
Yue Jiang, Department of Acupuncture, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Author contributions: Lin ZH and Jiang Y concepted the study, supervised the study, contributed to the investigation, the visualization of the study, and originally drafted the manuscript; Dai SF collected the data; Zhao JN contributed to the formal analysis; Dai SF and Zhao JN contributed to the methodology; Jiang Y validated the study; Lin ZH, Dai SF, Zhao JN and Jiang Y reviewed and edited the manuscript.
Institutional review board statement: The study was reviewed and approved by the Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yue Jiang, MD, Occupational Physician, Department of Acupuncture, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Nanbaixiang Street, Ouhai District, Wenzhou 325000, Zhejiang Province, China. jyygl9397@126.com
Received: March 14, 2023
Peer-review started: March 14, 2023
First decision: April 7, 2023
Revised: April 16, 2023
Accepted: April 24, 2023
Article in press: April 24, 2023
Published online: June 15, 2023
Abstract
BACKGROUND

Diabetic nephropathy (DN) is a microangiopathy of type 2 diabetes mellitus (T2DM), which can damage the kidney through various ways and mechanisms due to the nature of the disease, involving the renal interstitium and glomeruli. However, in the early stage of the disease, patients only showed kidney volume increase and glomerular hyperthyroidism, and typical symptoms that are difficult to arouse individual attention were noticed.

AIM

To observe the expression of serum retinol-binding protein (RBP) and urinary N-acetyl-β-D-glucosaminidase (NAG) in patients with DN, and to analyze their value in disease prediction, so as to provide new targets for early diagnosis and treatment of DN.

METHODS

The baseline data of 50 T2DM patients treated in our hospital between January 2021 and December 2022 were retrospectively reviewed and included in group A. The baseline data of 50 patients with type 2 DN admitted to our hospital during the same period were collected and included in group B. The baseline data and serum RBP and urine NAG expression were compared between the two groups to analyze their value in the early prediction of DN.

RESULTS

There was no significant difference in age, gender, duration of diabetes, combined hyperlipidemia and combined hypertension between the two groups (P > 0.05); the expression of urinary NAG and serum RBP in group B was higher than that in group A, and the difference was statistically significant (P < 0.05); a multiple logistic regression model was established, and the results showed that urinary NAG and serum RBP were related to the presence or absence of injury in diabetic patients, and overexpression of urinary NAG and serum RBP may be risk factors for renal injury in T2DM patients (OR > 1, P < 0.05); receiver operating curve curve was plotted, and the results showed that the area under the curve of urinary NAG and serum RBP expression alone and in combination for predicting DN was > 0.80, and the predictive value was satisfactory; bivariate Spearman linear correlation analysis showed that there was a positive correlation between urinary NAG and serum RBP expression in patients with DN (r = 0.566, P = 0.000).

CONCLUSION

The increased expression of urinary NAG and serum RBP may be the risk factors leading to the progression of T2DM to DN. The possibility of DN can be considered in patients with urinary NAG and serum RBP overexpression by examining the expression of urinary NAG and serum RBP in patients with T2DM in clinical practice.

Keywords: Diabetic nephropathy, Serum retinol-binding protein, Urinary N-acetyl-β-D-glucosaminidase, Prediction, Type 2 diabetes mellitus

Core Tip: Retinol-binding protein (RBP) can combine with thyroid transporters to form polymer complexes, and activated RBP can free in plasma, pass through glomerular filtration, and be absorbed and decomposed by renal tubules. N-acetyl-β-D-glucosaminidase is a high molecular glycoprotein acidic hydrolase, which is an intracellular lysosomal enzyme mainly present in body fluids, organ tissues and blood cells of the body, and has a high expression especially in the proximal renal tubules, thus being clinically used as an important indicator for the evaluation of renal tubular function.