Association of serum GAD-Ab,C-peptide and UACR with white matter changes and cognitive function in elderly patients with end-stage diabetic nephropathy
10.3969/j.issn.1009-0754.2025.11.011
- VernacularTitle:老年终末期糖尿病肾病患者血清GAD-Ab、c肽、UACR比值与脑白质改变及认知功能相关性研究
- Author:
Yu ZHOU
1
;
Qi WANG
;
Lingyan ZHANG
Author Information
1. 226300 江苏南通,南通市第六人民医院检验科
- Keywords:
Serum anti-glutamic acid decarboxylase antibody;
C-peptide;
The ratio of urinary microalbumin to urinary creatinine;
End-stage diabetic nephropathy,elderly;
Changes in white matter of brain;
Cognitive function
- From:
Journal of Navy Medicine
2025;46(11):1126-1132
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the association of serum anti-glutamic acid decarboxylase antibody(GAD-Ab),C-peptide,and urinary albumin-to-creatinine ratio(UACR)with the changes in white matter and cognitive function in elderly patients with end-stage diabetic nephropathy(ESDN).Methods A total of 128 elderly patients with ESDN admitted to Nantong Sixth People's Hospital from November 2023 to November 2024 were enrolled.According to the Fazekas classification,they were assigned to white matter lesion group(grades 1-3)or non-white matter lesion group(grade 0).The levels of GAD-Ab,C-peptide,and UACR were compared between the two groups.The correlations between white matter lesions and the levels of GAD-Ab,C-peptide,and UACR in elderly ESDN patients were investigated.According to the Mini-Mental State Examination(MMSE)score,the patients were assigned to non-cognitive dysfunction group(with an MMSE score of 27-30)or the cognitive dysfunction group(with an MMSE score of<27).The basic data of the two groups were compared.The factors influencing cognitive function in elderly ESDN patients were analyzed,and ROC curve was used to evaluate the correlation between influencing factors and the occurrence of cognitive dysfunction in elderly ESDN patients.Results Among 128 elderly patients with ESDN,81 had white matter lesions,accounting for 63.28%.The levels of GAD-Ab,C-peptide and UACR in the white matter lesion group were all higher than those in the non-white matter lesion group(P<0.05).The Pearson correlation analysis showed that the white matter lesions in ESDN patients were positively correlated with the levels of GAD-Ab,C-peptide and UACR(P<0.05).There were 42 patients with cognitive dysfunction,accounting for 32.81%.There were significant differences in the 24 h urine protein quantitation(Upro),C-peptide,GAD-Ab,UACR,GFR,procalcitonin and hs-CRP levels between the cognitive dysfunction group and the non-cognitive dysfunction group(P<0.05).Binary Logistic regression analysis showed that 24 h Upro(OR=1.006,95%CI:1.003 to 1.008),GAD-Ab(OR=34.923,95%CI:5.779 to 211.058),C-peptide(OR=2.891,95%CI:1.669 to 5.010),UACR(OR=1.066,95%CI:1.032 to 1.102),procalcitonin(OR=1.221,95%CI:1.103 to 1.352),and hs-CRP(OR=1.471,95%CI:1.232 to 1.757)were risk factors for cognitive dysfunction in elderly ESDN patients,while rGFR level(OR=0.967,95%CI:0.950 to 0.984)was a protective factor for cognitive dysfunction in elderly ESDN patients(P<0.05).ROC curve analysis showed that the sensitivities of GAD-Ab,C-peptide,and UACR in evaluating cognitive dysfunction in elderly ESDN patients were 68.30%,73.20%,and 65.90%,respectively.The specificities were 63.20%,64.40%,and 72.40%,respectively.Their combination had a relatively high value in predicting cognitive dysfunction in elderly ESDN patients(AUC=0.892).Conclusion GAD-Ab,C-peptide,and UACR are associated with white matter lesions in elderly ESDN patients,and the combination of the three indexes has a relatively high value in predicting cognitive dysfunction in elderly ESDN patients.
