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- [2022 Jan;46(1)] Renal Tubular Damage Marker, Urinary N-acetyl-β-D-Glucosaminidase, as a Predictive Marker of Hepatic Fibrosis in Type 2 Diabetes Mellitus
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- 2022.07.15
- Hit 395
- https://e-dmj.org/journal/view.php?number=2565 (클릭 174회)
Hae Kyung Kim1,*
, Minyoung Lee1,*, Yong-ho Lee1,2, Eun Seok Kang1,2, Bong-Soo Cha1,2, Byung-Wan Lee1,2
, Minyoung Lee1,*, Yong-ho Lee1,2, Eun Seok Kang1,2, Bong-Soo Cha1,2, Byung-Wan Lee1,2Corresponding author: Byung-Wan Lee https://orcid.org/0000-0002-9899-4992 Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea E-mail: bwanlee@yuhs.ac
* Hae Kyung Kim and Minyoung Lee contributed equally to this study as first authors.
Received November 24, 2020 Accepted April 20, 2021
Abstract
Background
Non-alcoholic steatohepatitis is closely associated with the progression of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM). We investigated whether urinary N-acetyl-β-D-glucosaminidase (u-NAG), an early renal tubular damage biomarker in DKD, could be related to the degree of hepatic fibrosis in patients with T2DM.
Methods
A total of 300 patients with T2DM were enrolled in this study. Hepatic steatosis and fibrosis were determined using transient elastography. The levels of urinary biomarkers, including u-NAG, albumin, protein, and creatinine, and glucometabolic parameters were measured.
Results
Based on the median value of the u-NAG to creatinine ratio (u-NCR), subjects were divided into low and high u-NCR groups. The high u-NCR group showed a significantly longer duration of diabetes, worsened hyperglycemia, and a more enhanced hepatic fibrosis index. A higher u-NCR was associated with a greater odds ratio for the risk of higher hepatic fibrosis stage (F2: odds ratio, 1.99; 95% confidence interval [CI], 1.04 to 3.82). Also, u-NCR was an independent predictive marker for more advanced hepatic fibrosis, even after adjusting for several confounding factors (β=1.58, P<0.01).
Conclusion
The elevation of u-NAG was independently associated with a higher degree of hepatic fibrosis in patients with T2DM. Considering the common metabolic milieu of renal and hepatic fibrosis in T2DM, the potential use of u-NAG as an effective urinary biomarker reflecting hepatic fibrosis in T2DM needs to be validated in the future.
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