Albeltagy Eman Salah, Hammour Abdallah Elsayed, Albeltagy Salah Ahmad
1Internal Medicine Department, Faculty of Medicine (For Girls), Al-Azhar University, Cairo, Egypt.
2Ophthalmology Department, Faculty of Medicine (For Males), Al-Azhar University, Cairo, Egypt.
J Diabetes Metab Disord. 2019 Apr 19;18(1):217-228. doi: 10.1007/s40200-019-00406-1. eCollection 2019 Jun.
The increasing prevalence of type 2 diabetes mellitus (T2DM) calls for evolving a concomitant screening strategies for early disease detection and prediction of the complications. Progranulin (PRGN) was recently introduced as a biomarker of inflammation in T2DM. However, little data have been published as regarding progranulin in relation to diabetic micro angiopathy among Egyptian patients with T2DM. The aim of this study was therefore to investigate and evaluate serum progranulin as a biomarker for the presence and severity of micro vascular complications among Egyptian patients with T2DM.
A total of 90 age and sex matched participants were included in this cross sectional study. They were divided into group 1 included 30 non diabetic healthy controls and group 2 included 60 patients with type 2 diabetes mellitus. Furthermore, diabetic patients were categorized into two subgroups depending on the presence or absence of microvascular complications. Evaluation for diabetic nephropathy, neuropathy and retinopathy were determined. Furthermore, laboratory investigations were performed and serum progranulin levels were measured by a quantitative sandwich enzyme linked immune sorbent assay.
The mean serum PRGN levels were significantly elevated in type 2 diabetic patients (20.90 ± 6.38 ng/ml) compared to control group (9.20 ± 1.41 ng/ml) ( < 0.001). Moreover,the serum PRGN levels were increased parallel to the severity of diabetic nephropathy (DN) and diabetic retinopathy (DR) with significantly highest detectable values were in macro albuminuric group of diabetic nephropathy as well as proliferative diabetic retinopathy (PDR) groups ( < 0.001). Besides, it worth mentioning that, the level of Serum progranulin started to increase significantly in stage 2 DN in spite of normal level of albuminuria. There were highly significant positive correlation between serum PRGN and disease duration, body mass index (BMI),fasting blood sugar (FBS), HbA1c, Total cholesterol (TC),triglyceride (TG), serum creatinine, ACR (r = 0.918, 0.623, 0.430, 0.539,0.910,0.842,0.759, 0.903, resp., < 0.001) and a significant positive correlation with low density lipoprotein (LDL) (r = 0.344),but there was a highly significant negative correlation between serum PRGN and eGFR ( = -0.866, < 0.001) in the studied diabetic patients.
Progranulin might be considered as a biomarker for diabetic micro angiopathy and its severity. In addition, there is a group of diabetic patients with decreased eGFR but without albuminuria in which serum PRGN level was indicated to be used as an early biomarker of diabetic nephropathy.
2型糖尿病（T2DM）患病率不断上升，需要制定相应的筛查策略以实现疾病的早期检测和并发症预测。前颗粒蛋白（PRGN）最近被引入作为T2DM炎症的生物标志物。然而，关于埃及T2DM患者中前颗粒蛋白与糖尿病微血管病变的相关数据鲜有发表。因此，本研究旨在调查和评估血清前颗粒蛋白作为埃及T2DM患者微血管并发症存在及严重程度的生物标志物。
本横断面研究共纳入90名年龄和性别匹配的参与者。他们被分为两组，第1组包括30名非糖尿病健康对照者，第2组包括60名2型糖尿病患者。此外，糖尿病患者根据是否存在微血管并发症分为两个亚组。对糖尿病肾病、神经病变和视网膜病变进行评估。此外，进行实验室检查，并通过定量夹心酶联免疫吸附测定法测量血清前颗粒蛋白水平。
与对照组（9.20±1.41 ng/ml）相比，2型糖尿病患者的平均血清PRGN水平显著升高（20.90±6.38 ng/ml）（P<0.001）。此外，血清PRGN水平随着糖尿病肾病（DN）和糖尿病视网膜病变（DR）的严重程度平行升高，在糖尿病肾病的大量白蛋白尿组以及增殖性糖尿病视网膜病变（PDR）组中可检测到的最高值显著升高（P<0.001）。此外，值得一提的是，尽管蛋白尿水平正常，但血清前颗粒蛋白水平在DN 2期就开始显著升高。血清PRGN与病程、体重指数（BMI）、空腹血糖（FBS）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、甘油三酯（TG）、血清肌酐、ACR之间存在高度显著的正相关（r分别为0.918、0.623、0.430、0.539、0.910、0.842、0.759、0.903，P<0.001），与低密度脂蛋白（LDL）存在显著正相关（r=0.344），但在研究的糖尿病患者中，血清PRGN与估算肾小球滤过率（eGFR）之间存在高度显著的负相关（r=-0.866，P<0.001）。
前颗粒蛋白可被视为糖尿病微血管病变及其严重程度的生物标志物。此外，有一组eGFR降低但无蛋白尿的糖尿病患者，其血清PRGN水平可作为糖尿病肾病的早期生物标志物。
