Clinical significance of serum homocysteine as a biomarker for early diagnosis of diabetic nephropathy in type 2 diabetes mellitus patients

Bin Ye,Xiaozhen Ji,Xiangying Zhu,Zhifu Zeng,Meixia Ji

doi:10.1515/pteridines-2020-0025

Abstract

Abstract Objective The aim of this study was to investigate the clinical significance of serum homocysteine (Hcy) as a biomarker for early diagnosis of diabetic nephropathy (DN) in type 2 diabetes mellitus (T2DM) patients. Methods Fifty-five T2DM patients with DN and 51 T2DM patients without DN were prospectively recruited from January 2016 to May 2020 in our hospital. The serum Hcy was tested by electrochemiluminescence assay in DN and T2DM groups and compared. The diagnostic efficacy of serum Hcy as a biomarker for early diagnosis of DN was evaluated by calculating the diagnostic sensitivity, specificity and area under the ROC curve (AUC). Results The serum levels of Hcy were 15.49 ± 5.40 and 9.23 ± 3.15 μmol/L for DN and T2DM patients, respectively, with statistical difference (t = 7.21, P < 0.001). In the DN group, the serum Hcy levels for patients with hyperfiltration, intermittent proteinuria, microalbuminuria, macroalbuminuria and uremic were 10.99 ± 2.57, 13.90 ± 2.86, 15.38 ± 4.77, 18.98 ± 4.36 and 23.31 ± 5.22 μmol/L, respectively, which indicated that serum Hcy levels in DN were higher than those of T2DM patients and correlated with patient’s renal damage. Using the serum Hcy level as the reference, the diagnostic sensitivity, specificity and AUC were 84.31 (71.41–92.98)%, 74.55 (61.00–85.33)% and 0.85 (0.78–0.92)%, respectively, with the cutoff value of 12.08 between DN and T2DM. The serum Hcy also had relatively good differential diagnostic efficacy between different DN stages with high sensitivity, specificity and AUC. Conclusion Serum Hcy was obviously elevated in DN compared to T2MD and correlated with the renal damage severity, which can be applied as a potential serological marker for early diagnosis of DN.

Highlights

Diabetes mellitus (DM) is one of the most frequent metabolic diseases and the prevalence of DM is rising [1,2].Diabetic nephropathy (DN), mostly characterized by proteinuria, is one of the most common microvascular complications of type 2 diabetes mellitus (T2DM) [3,4]
The inclusion criteria were as follows: (1) the patients were older than 18 years; (2) all the patients were diagnosed with T2MD according to the WHO diagnostic criteria for DM in 1999; (3) the patients met the diagnostic criteria for DN designated by the American Diabetes Association in 1977; (4) the patients did not take any drugs affecting renal function within 4 weeks before enrollment; and (5) no folic acid and VB12 intake within 3 months
We found that the serum level of Hcy was obviously elevated in DN cases compared to T2DM

Summary

Introduction

Diabetes mellitus (DM) is one of the most frequent metabolic diseases and the prevalence of DM is rising [1,2].Diabetic nephropathy (DN), mostly characterized by proteinuria, is one of the most common microvascular complications of type 2 diabetes mellitus (T2DM) [3,4]. Diabetes mellitus (DM) is one of the most frequent metabolic diseases and the prevalence of DM is rising [1,2]. Hypertension, edema, proteinuria, systemic microvascular disease and even renal failure were often identified in the uremia stage of DN patients [8]. Hcy is a kind of sulfur-containing amino acid, which is an intermediate product in the process of methionine metabolism [12]. It metabolizes through methylation and trans-sulfurization, maintaining the two major abilities of human body: methylation and antioxidation. Subsequent studies found that the increased serum Hcy level was an independent risk factor for cardiovascular and cerebrovascular diseases [17,18]

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