Plausible diagnostic value of urinary isomeric dimethylarginine ratio for diabetic nephropathy
Plausible diagnostic value of urinary isomeric dimethylarginine ratio for diabetic nephropathy
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DOI：
10.1038/s41598-020-59897-1
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发表时间：
2020-02-19
影响因子：
4.6
通讯作者：
Panchagnula, Venkateswarlu
中科院分区：
文献类型：
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作者：
Parmar, Dharmeshkumar;Bhattacharya, Nivedita;Panchagnula, Venkateswarlu
循环不对称和对称二甲基精氨酸的改变在终末期肾衰竭患者中有独立的报道，表明它们作为肾病的介质和早期生物标志物的潜在作用。这些变化也可反映在尿液中。在此，我们旨在评估尿不对称与对称二甲基精氨酸比值（ASR）在糖尿病肾病（DN）早期预测中的价值。在这项横断研究中，从印度Mohans博士的糖尿病专科中心招募了糖耐量受损（IGT）、新诊断糖尿病（NDD）、糖尿病微量白蛋白尿（MIC）、大量白蛋白尿（MAC）和正常糖耐量（NGT）的患者。采用经过验证的高通量MALDI-MS/MS方法测量尿液ASR。与NGT和NDD组相比，MIC组（0.909）和MAC组（0.741）的ASR显著降低。在回归模型中，ASR与MIC相关[OR: 0.256；95% CI: 0.158-0.491]和MAC [OR 0.146；95% CI: 0.071-0.292]控制了所有可能的混杂因素。ROC分析显示，ASR cut point为0.95，c统计量为0.691 (95% CI: 0.627-0.755)，对MIC和NDD的鉴别灵敏度为72%。然而，ASR截断点为0.82，c统计量为0.846 (95% CI: 0.800 - 0.893)，识别MAC的灵敏度为91%。我们的结果表明，ASR是亚洲印第安人DN的潜在早期诊断生物标志物。
Altered circulatory asymmetric and symmetric dimethylarginines have been independently reported in patients with end-stage renal failure suggesting their potential role as mediators and early biomarkers of nephropathy. These alterations can also be reflected in urine. Herein, we aimed to evaluate urinary asymmetric to symmetric dimethylarginine ratio (ASR) for early prediction of diabetic nephropathy (DN). In this cross-sectional study, individuals with impaired glucose tolerance (IGT), newly diagnosed diabetes (NDD), diabetic microalbuminuria (MIC), macroalbuminuria (MAC), and normal glucose tolerance (NGT) were recruited from Dr. Mohans' Diabetes Specialties centre, India. Urinary ASR was measured using a validated high-throughput MALDI-MS/MS method. Significantly lower ASR was observed in MIC (0.909) and MAC (0.741) in comparison to the NGT and NDD groups. On regression models, ASR was associated with MIC [OR: 0.256; 95% CI: 0.158-0.491] and MAC [OR 0.146; 95% CI: 0.071-0.292] controlled for all the available confounding factors. ROC analysis revealed ASR cut-point of 0.95 had C-statistic of 0.691 (95% CI: 0.627-0.755) to discriminate MIC from NDD with 72% sensitivity. Whereas, an ASR cut-point of 0.82 had C-statistic of 0.846 (95% CI: 0.800 - 0.893) had 91% sensitivity for identifying MAC. Our results suggest ASR as a potential early diagnostic biomarker for DN among the Asian Indians.