Expression Analysis of Urinary Exosome in Type 2 Diabetic Kidney Disease and Evaluation of Its Clinical Diagnostic Value

Study Overview
=================
Brief Summary
-----------------
Expression analysis of urinary exosome miR-136-5p in type 2 diabetic nephropathy and evaluation of its clinical diagnostic value

Detailed Description
-----------------
Preliminary screening of miRNAs: Through GEO database and reading related literature, miRNAs differentially expressed in type 2 diabetes and diabetic nephropathy were selected as potential candidate biomarkers for follow-up verification. Collection and treatment of clinical samples: Urine of diabetic patients was collected from the First Affiliated Hospital of Shandong First Medical University in strict accordance with the drainage standard, and the basic information of patients was registered. Meanwhile, the collected samples were divided into type 2 diabetes group and diabetic nephropathy group according to whether the urine was accompanied by UACR≥300/g. Subsequently, the collected samples were centrifuged and retained for supernatant. Isolation and identification of urinary exosomes: Ultrafast centrifugation method was used to separate the treated urine samples of exosomes, and then identified by transmission electron microscopy, nanoparticle analysis and Western blot respectively. Real-time PCR was used to detect the changes in urinary exosomal miRNA expression levels of the two groups of patients, and statistical analysis and correlation analysis of clinical indicators of the differentially expressed mirnas were performed. Target gene prediction and enrichment pathway analysis of differentially expressed mirnas were performed to screen out pathways that might be related to the occurrence and development of DKD, and then the relevant pathways were verified by immunofluorescence, immunocoprecipitate, Western blot, Real- time PCR and other methods.

Official Title
-----------------
Expression Analysis of Urinary Exosome miR-136-5p in Type 2 Diabetic Nephropathy and Evaluation of Its Clinical Diagnostic Value

Conditions
-----------------
Diabetic Nephropathy

Intervention / Treatment
-----------------
* Other: Grouping based on previous laboratory results, no intervention.


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Age ≥18 years old; Previously diagnosed with type 2 diabetes; Typical diabetic symptoms (polydipsia, polydipsia, polyuria and weight loss) plus random blood glucose ≥11.1mmol/l; Fasting blood glucose ≥7.0mmol/l, fasting is defined as at least 8 hours without intake of calories; Oral glucose tolerance test (OGTT) 2-hour blood glucose ≥11.1mmol/ l, using a glucose load equivalent to 75 grams of anhydrous glucose dissolved in water (venous blood was drawn in all patients; With or without UACR≥300mg/g. Exclusion Criteria: Refused to enroll patients; Type 1 diabetic nephropathy and other special types of diabetic nephropathy; 3.Patients with kidney stones and urinary system infection; 4.Patients with autoimmune system diseases, malignant tumors, and blood system diseases; 5.Patients with severe chronic cardiopulmonary disease, chronic liver and kidney disease; 6.Patients with severe infectious diseases; #7#Use of glucocorticoids, immunosuppressants or cytotoxic drugs.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Type 2 diabetes group<br>The group was based on the clinically confirmed diagnosis of type 2 diabetes | Other: Grouping based on previous laboratory results, no intervention.<br>* The patients were grouped according to the results of previous inpatient tests, and no intervention measures were taken<br>|
| Diabetic nephropathy group<br>The group was based on the clinically confirmed diagnosis of type 2 diabetes.The group was based on the clinically confirmed diagnosis of type 2 diabetes.Patients were re-screened strictly according to the following admission criteria: persistent albuminuria and/or decreased eGFR,while other causes of chronic kidney disease (CKD) were excluded. When diabetes mellitus is identified as the cause of kidney damage and other primary and secondary glomerular diseases and systemic diseases are excluded, at least one of the following conditions can be diagnosed as DKD: (1) Urinary Albumin/Creatinine Ratio(UACR)≥30 mg/g or Urinary albumin excretion rate (UAER)≥30 mg/24 h, The UACR or UAER was checked again within 3 to 6 months, and 2 out of 3 times reached or exceeded the critical value; Eliminate other interfering factors such as infection; (2) eGFR&lt; 60 ml·min-1.(1.73 m2) -1 for more than 3 months;(3) Renal biopsy was consistent with DKD pathological changes. | Other: Grouping based on previous laboratory results, no intervention.<br>* The patients were grouped according to the results of previous inpatient tests, and no intervention measures were taken<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Preliminary screening of miRNA | Through GEO database and reading related literature, mirnas that are differentially expressed in type 2 diabetes and diabetic nephropathy were selected as potential candidate biomarkers for follow-up verification. | 2020-2024 | 
| Clinical sample collection and processing | The urine of diabetic patients was collected from the First Affiliated Hospital of Shandong First Medical University in strict accordance with the drainage standard, and the basic information of patients was registered. Meanwhile, the collected samples were divided into type 2 diabetes group and diabetic nephropathy group according to whether the urine was accompanied by UACR≥300/g. Subsequently, the collected samples were centrifuged and retained for supernatant. | 2020-2024 | 
| Statistical analysis and target gene prediction of misexpressed mirnas and enrichment pathway analysis | Statistical analysis and correlation analysis of clinical indicators of differenti ally expressed mirnas were performed to further evaluate their clinical diagnostic value.Subsequently, the target gen es of the mirnas differentially expressed in urinary exosomes of the two groups were analyzed by miRTarBase datab base and R software package, and the relevant pathways were screened out through KEGG enrichment pathway a analysis. Subsequently, the relevant pathways were verified by immunofluorescence, immunocoprecipitation, We estern blot, Real-time PCR and other methods. | 2020-2024 |