Clinical usefulness of human serum nonmercaptalbumin to mercaptalbumin ratio as a biomarker for diabetic complications and disability in activities of daily living in elderly patients with diabetes
Clinical usefulness of human serum nonmercaptalbumin to mercaptalbumin ratio as a biomarker for diabetic complications and disability in activities of daily living in elderly patients with diabetes
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DOI：
10.1016/j.metabol.2019.153995
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发表时间：
2020-02-01
影响因子：
9.8
通讯作者：
Inoguchi, Toyoshi
中科院分区：
文献类型：
--
作者：
Fukuhara, Saki;Yasukawa, Keiko;Inoguchi, Toyoshi
背景：氧化应激可能在糖尿病并发症的发生发展中起重要作用。人非巯基白蛋白（HNA;氧化形式）与人巯基白蛋白（HMA;还原形式）的比率作为系统性氧化还原状态的指标引起了关注。在本研究中，我们测量了老年糖尿病患者的比率，并评估了其与糖尿病并发症和日常生活活动能力（ADL残疾）的关系。方法：连续招募了2018年4月至2018年6月期间在Yukuhashi中央医院接受医疗护理的126名70岁及以上老年糖尿病患者。通过高效液相色谱法测量HNA%，定义为HNA/（HNA + HMA）X 100。首先，进行多变量回归分析，以评估哪些变量是HNA%的重要决定因素。接下来，为了评估HNA%与ADL残疾的关联，在各种模型中进行逻辑回归分析。然后我们绘制受试者工作特征（ROC）曲线，并计算每个模型的曲线下面积（AUC）、灵敏度和特异性。在老年糖尿病患者中，多元回归分析显示，血清胆红素水平和白蛋白水平，这两者都是主要的内源性抗氧化剂，与慢性肾功能衰竭（或增殖性肾病）与HNA%显著相关，表明HNA%可能是这些患者中氧化应激的良好生物标志物。然后，我们在各种逻辑回归模型中评估了HNA%与ADL残疾的相关性。仅用HNA%建立的模型显示，HNA %是ADL功能障碍的显著决定因素（OR 1.158，95% CI 1.077-1.244，P < 0.001）。以HNA%和年龄建立的模型显示，两个变量均为ADL残疾的显著决定因素（OR分别为1.160，95% CI 1.069-1.258，P < 0.001; OR为1.258，95% CI 1.110-1.427，P < 0.001）。ROC分析显示，HNA%单独的AUC为0.765。结论：HNA%与老年糖尿病并发症及ADL功能障碍显著相关，可作为老年糖尿病患者氧化应激指标。(C)2019爱思唯尔公司All rights reserved.
Background: Oxidative stress may play an important role in the development of diabetic complications. The ratio of human nonmercaptalbumin (HNA; oxidized form) to human mercaptalbumin (HMA; reduced form) has attracted attention as an indicator for systemic redox states. In this study, we measured the ratio in elderly patients with diabetes and evaluated its association with diabetic complications and disability in activities of daily living (ADL disability).Methods: One hundred twenty-six elderly patients with diabetes, aged 70 years and older, under medical care at Yukuhashi Central Hospital from April 2018 to June 2018, were continuously recruited. HNA%, defined as HNA/(HNA + HMA) x 100, was measured by a high-performance liquid chromatography method. First, multivariate regression analysis was performed to evaluate which variables were significant determinants for HNA%. Next, to evaluate the association of HNA% with ADL disability, logistic regression analysis in various models was performed. Then we plotted the receiver operating characteristic (ROC) curve and calculated the under area the curve (AUC), sensitivity, and specificity in each model.Results: In elderly patients with diabetes, multiple regression analysis showed that serum bilirubin levels and albumin levels, both of which are major endogenous anti-oxidants, and chronic renal failure (or proliferative nephropathy) were significantly associated with HNA%, suggesting that HNA% may be a good biomarker for oxidative stress in those patients. We then evaluated the association of HNA% with ADL disability in various logistic regression models. Model using only HNA% showed that it was a significant determinant for ADL disability (OR 1.158, 95% CI 1.077-1.244, P < 0.001). Model using HNA% and age showed that both variables were significant determinants for ADL disability (OR 1.160, 95% CI 1.069-1.258, P < 0.001; OR 1.258, 95% CI 1.110-1.427, P < 0.001, respectively). ROC analysis showed that the AUC of HNA% alone was 0.765. The AUC of model using HNA% and age was further increased to 0.866.Conclusions: HNA% was significantly associated with diabetic complications and ADL disability, thereby may be clinically useful as an oxidative stress marker in elderly patients with diabetes. (C) 2019 Elsevier Inc. All rights reserved.