Clin Lab. 2023 Nov 1;69(11). doi: 10.7754/Clin.Lab.2023.230516.
Lipocalin-2 (LCN2) level in type 2 diabetes mellitus (T2DM) subgroups has not been investigated. The aim of this study was to investigate LCN2 levels, insulin resistance, urinary albumin excretion, and inflammation status in T2DM subgroups.
A total of 251 patients with newly diagnosed T2DM were evaluated. LCN2, glycated hemoglobin (HbA1c), FPG, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hsCRP) levels were measured. Patients with diabetes were categorized into three subgroups: patients diagnosed with fasting plasma glucose (FPG) alone (FPG-DM), those with isolated hemoglobin A1c (HbA1c) diabetes (A1c-DM), and those who met the criteria for both FPG and HbA1c (FPG/A1c-DM). The albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), homeostasis model assessment of insulin resistance (HOMA-IR), and adjusted LCN2 values, such as the LCN2/inflammation index (LCN2/Inf) and LCN2/creatinine (LCN2/ Cr), were calculated.
The ACR, HOMA-IR, and glycosuria prevalence were significantly higher in FPG-DM than in A1c-DM. In contrast, no significant difference was observed in LCN2, eGFR, and proinflammatory cytokine levels between the two groups. Patients with FPG/A1c-DM had significantly higher LCN2, TNF-α, IL-6, and hsCRP levels than those with A1c-DM or FPG-DM. The percent difference between LCN2 and LCN2/Inf was 3.2-fold greater than that between LCN2 and LCN2/Cr in FPG/A1c-DM. The presence of FPG-DM led to a 1.8-fold increase in the prevalence of proteinuria (odds ratio, 1.876; 95% CI, 1.014 - 3.295; p < 0.001). The ability of FPG to identify proteinuria outperformed that of HbA1c (area under the curve: 0.629, 95% CI, 0.553 - 0.706 versus 0.522, 95% CI, 0.436 - 0.605, p < 0.001).
LCN2 elevation may be more largely due to inflammation than kidney function, particularly in FPG/A1c-DM. Patients with FPG-DM may be at a greater risk of diabetic nephropathy and insulin resistance than those with A1c-DM.
2 型糖尿病（T2DM）亚组的脂联素-2（LCN2）水平尚未得到研究。本研究旨在探讨 T2DM 亚组的 LCN2 水平、胰岛素抵抗、尿白蛋白排泄和炎症状态。
评估了 251 例新诊断的 T2DM 患者。测量了 LCN2、糖化血红蛋白（HbA1c）、空腹血糖（FPG）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和高敏 C 反应蛋白（hsCRP）水平。将糖尿病患者分为三组：仅诊断为空腹血糖（FPG）的患者（FPG-DM）、仅诊断为血红蛋白 A1c（HbA1c）的糖尿病患者（A1c-DM）和同时符合 FPG 和 HbA1c 标准的患者（FPG/A1c-DM）。计算白蛋白与肌酐比值（ACR）、估计肾小球滤过率（eGFR）、稳态模型评估的胰岛素抵抗（HOMA-IR）和调整后的 LCN2 值，如 LCN2/炎症指数（LCN2/Inf）和 LCN2/肌酐（LCN2/Cr）。
FPG-DM 患者的 ACR、HOMA-IR 和糖尿患病率明显高于 A1c-DM。相比之下，两组之间 LCN2、eGFR 和促炎细胞因子水平无显著差异。FPG/A1c-DM 患者的 LCN2、TNF-α、IL-6 和 hsCRP 水平明显高于 A1c-DM 或 FPG-DM。FPG/A1c-DM 患者的 LCN2 与 LCN2/Inf 之间的差异百分比是 LCN2 与 LCN2/Cr 之间差异百分比的 3.2 倍。FPG-DM 患者的蛋白尿患病率增加了 1.8 倍（优势比，1.876；95%置信区间，1.014-3.295；p<0.001）。FPG 识别蛋白尿的能力优于 HbA1c（曲线下面积：0.629，95%置信区间，0.553-0.706 与 0.522，95%置信区间，0.436-0.605，p<0.001）。
LCN2 的升高可能主要归因于炎症而不是肾功能，尤其是在 FPG/A1c-DM 中。与 A1c-DM 相比，FPG-DM 患者发生糖尿病肾病和胰岛素抵抗的风险可能更高。
