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Objective: To research the clinical value of Cystatin C,N-acetyl-beta-D- glucosaminidase and neutrophil gelatinase associated lipocalin on early diagnosis of diabetic nephropathy.Meanwhile we observe the changes of some clotting index in patients with diabetes such as von Willebrand factor,GMP-140,protein C,and so on.Methods: There are thirty healthy adults in control group, thirty-two patients in diabetes mellitus group and twenty-five patients in diabetic nephropathy group.We have observed these index such as serum creatinine,Hs-CRP and Platelet parameters(PLT,MPV,PCT,PDW).We have detected the levels of urinary albumin and urine creatine by Turbidimetry-immunoassay, and detected these index (CysC、NGAL、vWF、GMP-140、t-PA、PAI-1) in plasma and these index (Cys C、NGAL、NAG) in urine by ELISA. Stago coagulation analyzer was used to detect the levels of plasma Fbg and AT-Ⅲand PC and S.Results:(1) DN patients’serum concentration of Cys C is (1.54±0.56)mg/L,higher than DM group and control group significantly(P<0.05).The level of serum NAGL in DN group is (7.68±0.97)ug/L, and is (7.08±1.01)ug/L in DM group, both have difference with control group significantly.The concentration of urine Cys C and NAG in DN group are higher than that in DM group (P=0.000,P=0.006), but no difference was found between DM group and control group(p>0.05). The level of urine NGAL is (18.77±8.94)ug/g Cr in DN group, and is (11.50±6.42)ug/g Cr in DM group,both are higher than control group(0.000,0.014).Correlation analysis shows plasma Cys C and NGAL are positively correlated with serum creatinine(r=0.805,r=0.642), and urine CysC and NAG and NGAL are positively correlated with UACR (r=0.596,r=0.497,r=0.538).(2) Plasma level of Hs-CRP in DN patients is (4.52±2.07)mg/L,significantly higher than DM patients(p=0.01),and the both groups are significantly different from the control group.DN patients’plasma vWF activity is (315.53±47.24)%,significantly higher than DM patients’(191.88±57.25)%,and both are significantly different from control group (p<0.001).DM group’s Platelet parameters(PLT、MPV、PDW、PCT)have no difference with control group. MPV and PDW are highest in DN group (p<0.05).Compared with DM group,plasma GMP-140 increase to (30.03±7.77)ng/ml significantly in DN group (p<0.001),and the both groups are significantly higher than control group(P=0.009,P=0.000).Correlation analysis shows that plasma vWF and GMP-140 are positively correlated with Hs-CRP (r=0.620,r=0.455),and are positively correlated with UACR (r=0.620,r=0.680).Hs-CRP is positively correlated with UACR (r=0.449).(3) DN group’s plasma fibrinogen is (4.20±1.53)g/L,higher than (3.21±0.89)g/L in DM group(p=0.002),and the latter is significantly different with control group(P=0.017).Activity of plasma Protein C is (109.40±32.32)% in DM group,and is (95.20±28.03)% in DN group,there is no difference between them,but both are higher than (80.27±14.22)% in control group (P=0.000,P=0.014).Activity of plasma Protein S is (90.75±19.60)% in DM group,and is (85.12±22.48)% in DN group,there is no difference between them,but both are higher than control group (P<0.001).The level of plasma thrombin-Ⅲhas no significant difference among three groups.DN patients’level of plasma t-PA is (6.13±1.83)ng/ml,less than (7.29±1.93)ng/ml in DM group(p=0.019),plasma t-PA in DM group has no difference from control group(p>0.05).DN patients’level of plasma PAI-1 is (34.29±5.22)ng/ml in DN group,significantly different with (31.03±5.18)ng/ml in DM group (p=0.018),the latter is higher than (27.80±4.73)ng/ml in control group.Correlation analysis shows that UACR is positively correlated with Fbg and PAI-1(r=0.313,r=0.333),and is negatively correlated with PC(r=-0.255).Conclusions:(1) Serum Cys C and NGAL has elevated in diabetes,especially in patients with microalbuminuria,and both indexes have positive relationship with serum creatinine,so we guess serum Cys C and NGAL could predict early kidney damage in DM patients.Urine Cys C ,NAG and NGAL significantly rise in the DN patients,and positively correlated with UACR,we also found urine NGAL has risen in DM patients,so these Could reflect early renal tubular damage in diabetes,and urine NGAL may be the earliest.(2) Plasma vWF increases in the DM patients,especially when diabetic nephropathy takes place,that demonstrate endothelial damage and dysfunction in DM patients,and it will be still further serious in those patients with early DN.Plasma MPV and PDW and P-selectin have significantly rised in early DN patients, which indicate there is change of Platelet traits and function in early DN patients.(3) DM patients have some coagulation abnormalities such as hyperfibrinogenemia, high level of anticoagulant protein(PC、PS) and PAI-1 and then plasma t-PA declines,finally,result in a hypercoagulable state and decreased fibrinolysis in DM patients,more prone to thrombosis.
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