Correlation between the levels of serum cystatin C and substance P in peripheral blood in diabetes mellitus patients complicated with hypertension

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1 EXPERIMENTAL AND THERAPEUTIC MEDICINE 16: , 2018 Correltion between the levels of serum cysttin C nd substnce P in peripherl blood in dibetes mellitus ptients complicted with hypertension WEI ZHU 1, XUELIAN GONG 2, CHAO LUO 3 nd JING LU 4 1 Deprtment of Clinicl Lbortory, Boji Centrl Hospitl, Boji, Shnxi ; 2 Deprtment of Internl Medicine, Xi'n No. 5 Hospitl, Xi'n, Shnxi ; 3 Bsic Medicl College, Hubei University of Science nd Technology, Xinning, Hubei ; 4 Deprtment of Geritrics, No. 215 Hospitl of Shnxi Nucler Industry, Xinyng, Shnxi , P.R. Chin Received September 1, 2017; Accepted My 23, 2018 DOI: /etm Abstrct. Correltion between the serum cysttin C nd substnce P in peripherl blood of dibetes mellitus ptients complicted with hypertension ws investigted. Dibetes mellitus ptients with or without hypertension were selected in No. 215 Hospitl of Shnxi Nucler Industry from December 2015 to Februry There were 60 ptients with only hypertension (hypertension control group), 60 ptients with only dibetes mellitus (dibetes mellitus control group) nd 60 ptients with dibetes mellitus combined with hypertension (observtion group). Levels of serum cysttin C nd substnce P in peripherl blood were mesured vi immunoturbidimetry nd enzyme-linked immunosorbent ssy, respectively, nd the correltion with hypertension ws nlyzed. The verge level of serum cysttin C in the observtion group ws higher thn tht of the two control groups (P<0.05). The level of substnce P in peripherl blood of the observtion group ws lower thn tht of the dibetic control group (P<0.05). The levels of serum cysttin C in ptients with grde Ⅲ hypertension in observtion group were higher thn those in grdes II nd I, nd the levels of substnce P in peripherl blood of ptients with grde Ⅲ hypertension in observtion group were lower thn those in grdes II nd I. Systolic pressure of ptients in observtion group ws significntly positively correlted with level of serum cysttin C, but significntly negtively correlted with level of substnce P in peripherl blood (P<0.05). Compred with the dibetes mellitus ptients, level of serum cysttin C ws higher, nd level of substnce P peripherl blood ws lower in dibetes Correspondence to: Dr Jing Lu, Deprtment of Geritrics, No. 215 Hospitl of Shnxi Nucler Industry, 35 Weiyngxi Rod, Xinyng, Shnxi , P.R. Chin E-mil: byu2jn@163.com Key words: dibetes mellitus, hypertension, serum cysttin C, substnce P in peripherl blood mellitus ptients complicted with hypertension. In dibetes mellitus ptients, blood pressure ws positively correlted with serum cysttin C level, nd negtively correlted with substnce P level in peripherl blood. Introduction Increses in blood pressure re lwys ccompnied with the elevted risks in crdiovsculr diseses, such s myocrdil infrction, hert filure nd stroke. Aging of popultion in Chin increses the risk of hypertension nd its crdiovsculr (1). In dibetes mellitus (DM) ptients, risk of crdiovsculr complictions, coronry rtery disese (CAD), cerebrl stroke nd peripherl rteril diseses re two to four times higher thn tht in people without DM (2,3). DM is lwys ccompnied with hypertension, nd, thus, DM ptients complicted with hypertension usully suffer from n incresed risk of crdiovsculr complictions (4). Corresponding studies hve reported tht during the follow up period of DM ptients without crdiovsculr diseses, the risk of crdiovsculr diseses is lmost equivlent to non-dm ptients with history of crdiovsculr diseses (5,6). Serum cysttin C is kind of kidney-secreted enzyme tht is widely distributed in the body, nd cn reflect the filtrting function of glomerulus (7). Dibetes nd hypertension often ffect kidneys. However, there is no report on the serum levels of cysttin C in ptients with dibetes mellitus combined with hypertension. We hypothesized tht serum cysttin C my hve some predictive vlue in detecting renl dmge in ptients with hypertension or dibetes without clinicl renl impirments (proteinuri nd renl insufficiency), wheres those with dibetes mellitus combined with hypertension re more likely to hve renl dmge in the erly stge, nd serum cysttin C levels my be higher in these ptients thn in ptients with only dibetes. Substnce P refers to kind of neuropeptide widely distributed in fine nerve fibers. When the nerve is stimulted, substnce P cn be relesed through the centrl end nd peripherl end, nd bind to neurokinin-1 receptor (NK1) to exert the physiologicl function. Peripherl neuropthy is one of the common complictions of DM. There

2 1160 ZHU et l: CORRELATION BETWEEN THE LEVELS OF CYSTATIN C AND SUBSTANCE P IN DM PATIENTS is usully n increse in substnce P in ptients with dibetes mellitus combined peripherl neuropthy. However, there is no report on the effect of hypertension on substnce P in ptients with dibetes mellitus. In order to mesure the concentrtion of serum cysttin C nd substnce P in peripherl blood of DM ptients with hypertension, DM ptients, hypertension ptients nd DM ptients with hypertension were selected from December 2015 to Februry There were 60 ptients with only DM (control group), 60 ptients with only hypertension (control group) nd 60 DM ptients with hypertension (observtion group). We mesured levels of serum cysttin C nd substnce P in peripherl blood of ll the ptients. Ptients nd methods Generl dt of ptients. DM ptients with or without hypertension who were dmitted to No. 215 Hospitl of Shnxi Nucler Industry (Xinyng, Chin) between December 2015 nd Februry 2017 were enrolled in this study. Inclusion criteri: i) Ptients ged between 40 nd 80 yers; ii) ptients met the Dignostic Criteri of Dibetes Mellitus (2010 edition, Americn Dibetes Assocition): i) glycosylted hemoglobin (HbA1c) 6.5%; ii) fsting plsm glucose (FPG) 7.0 mmol/l (ptients fsted for 8 h); iii) 2 h plsm glucose in orl glucose tolernce test 11.1 mmol/l; iv) rndom blood sugr 11.1 mmol/l for ptients with the typicl symptoms or crisis of high glucose; c) ptients whose systolic pressure reched or exceeded 21.3 kp (160 mmhg) nd distolic pressure reched or exceeded 12.7 kp (95 mmhg). Hypertension clssifiction ws bsed on the 1999 WHO/ISH guidelines for the tretment of hypertension (8). Exclusion criteri: ) ptients with type I DM; b) ptients complicted with renl insufficiency, hemturesis or proteinuri; c) ptients complicted with severe infections; d) ptients complicted with tumors. Among these ptients, we selected 60 DM ptients complicted with hypertension s observtion group. Those ptients included 26 mles nd 35 femles nd the ge rnged from 46 to 80 yers, with n verge of 65.3±5.6 yers. For hypertension grding, there were 16 with hypertension of grde I, 18 of grde II nd 26 of grde III. Sixty ptients with simple dibetes (28 mles nd 32 femles, ged yers, men ge 66.2±5.2 yers nd simple hypertension in 60 ptients (30 mles nd 30 femles, ged yers, men ge 65.8±6.1 yers s the control group in this study. There were 28 mles nd 32 femles, nd the ge rnged from yers with n verge of 66.2±5.2 yers. No sttisticl significnce ws found in comprisons of ge nd sex mong groups. This study ws pproved by the Ethics Committee of Boji Centrl Hospitl (Boji, Chin), nd ll the ptients or their fmily signed the informed consent. Detection of serum cysttin C. Fsting venous (3 ml) blood ws extrcted from ech ptient in the morning to detect serum cysttin C by prticle reinforcement prticle-enhnced turbidimetric immunossy (PETIA) using Olympus AU 2700 utomtic biochemicl nlyzer (Ningbo Purebio Biotechnology Co., Ltd., Ningbo, Chin) in ccordnce with the instructions of kit nd pprtus. Detection of substnce P level in peripherl blood. Enzymelinked immunosorbent ssy (ELISA) ws performed using n ELISA kit (R&D Systems, Inc., Minnepolis, MN, USA) to detect substnce P in peripherl blood of ech ptient in strict ccordnce with the instruction of the kit. Elbow venous blood (3 ml) ws collected, followed by centrifugtion t 2,500 x g t 4 C for 15 min, nd the seprted plsm ws stored t -70 C before use. OD vlues t 492 nm were detected to clculte the content of substnce P in peripherl blood. Sttisticl nlysis. SPSS 22.0 (IBM Corp., Armonk, NY, USA) softwre ws used. All mesurement dt were expressed s men ± stndrd devition, nd independent smple t-test. Comprison between groups ws done using one-wy ANOVA test followed by post hoc test (Lest Significnt Difference). Enumertion dt were expressed s No. (cse) or percentge, nd Chi-squre test ws performed for intergroup comprisons. Spermn's correltion nlysis ws dopted for correltion nlyses. P<0.05 ws considered to indicte sttisticlly significnt difference. Results Comprison of the levels of serum cysttin C nd substnce P in peripherl blood of ptients in three groups. There ws no significnt difference in serum cysttin C nd peripherl blood substnce P levels between dibetes control group nd hypertension control group. Averge level of serum cysttin C ws significntly higher in observtion group thn in the two control groups. The level of substnce P in peripherl blood in the observtion group ws lower thn tht in the dibetic control group (P<0.05), but there ws no difference between the observtion group nd the hypertension control group (P>0.05). Averge levels of serum cysttin C nd substnce P in peripherl blood of observtion group were 1.18±0.53 mg/l nd ±28.37 ng/l, respectively, nd those in dibetes control group were 1.04±0.48 mg/l nd ±27.06 ng/l, respectively. Significnt differences were found between two groups (t=2.185, t=1.028, P<0.05) (Tble I). Comprison of the levels of serum cysttin C nd substnce P in peripherl blood in ptients with different grdes of hypertension in observtion group. There ws no sttisticlly significnt difference between the distributions of ptients with grde I, II nd III hypertension in the hypertension-only control nd the observtion groups (P>0.05). In observtion group, level of serum cysttin C ws significntly higher, while substnce P level in peripherl blood ws significntly lower in ptients with grde III hypertension thn those in the ptients with grde I or II hypertension (P<0.05). Comprisons of the serum cysttin C level nd substnce P level in peripherl blood between ptients with grde I nd II hypertension showed no sttisticl significnce (P>0.05). In control group, serum levels of cysttin C in ptients with level III hypertension were significntly higher thn those in ptients with level II nd I, while no significnt difference ws found between level II nd I in serum levels of cysttin C nd levels of substnce P in peripherl blood (P>0.05). No significnt differences were found between ptients in observtion group nd control group with the sme level of hypertension (P>0.05) (Tbles II nd III).

3 EXPERIMENTAL AND THERAPEUTIC MEDICINE 16: , Tble I. Comprison of the levels of serum cysttin C nd substnce P in peripherl blood of ptients in two groups (men ± SD). Serum cysttin Substnce P in Groups No. C (mg/l) peripherl blood (ng/l) Observtion ± ±28.37 Dibetes control ± ±27.06 Hypertension control ± ±27.13 t vlue b t vlue P vlue <0.05 <0.05 b P vlue <0.05 >0.05 t nd P<0.05 vs. dibetes control group, b t nd b P<0.05 vs. hypertension control group. SD, stndrd devition. Tble II. Comprison of serum cysttin C levels between ptients in observtion group nd hypertension-only control group with different levels of hypertension (men ± SD). Observtion Hypertension-only control Levels Cses Serum cysttin C (mg/l) Cses Serum cysttin C (mg/l) P-vlue Ⅲ ± ±0.64 >0.05 II ± ±0.51 b >0.05 I ± ±0.43 b >0.05 F-vlue P-vlue <0.05 <0.05 In observtion group, serum levels of cysttin C in ptients with level III hypertension were significntly higher thn those in ptients with level II nd I; b In hypertension-only control, serum levels of cysttin C in ptients with level III hypertension were significntly higher thn those in ptients with level II nd I. Tble III. Comprison of levels of P substnce in peripherl blood between ptients in observtion group nd hypertension-only control with different levels of hypertension (men ± SD). Observtion Hypertension-only control P substnce in P substnce in Levels Cses peripherl blood (ng/l) Cses peripherl blood (ng/l) P-vlue Ⅲ ± ±25.67 >0.05 II ± ±26.91 b >0.05 I ± ±27.31 b >0.05 F vlue P-vlue <0.05 <0.05 In observtion group, levels of P substnce in peripherl blood in ptients with level III hypertension were significntly lower thn those in ptients with level II nd I; b In hypertension-only control, levels of P substnce in peripherl blood in ptients with level III hypertension were significntly lower thn those in ptients with level II nd I. Correltion of the systolic pressure with the levels of serum cysttin C nd substnce P in peripherl blood of ptients in the observtion group. Correltion nlysis showed tht systolic pressure of ptients in the observtion group ws significntly positively correlted with level of serum cysttin C (r=0.437, P<0.05), but significntly negtively correlted with the level of substnce P in peripherl blood (r= -0405, P<0.05) (Fig. 1).

4 1162 ZHU et l: CORRELATION BETWEEN THE LEVELS OF CYSTATIN C AND SUBSTANCE P IN DM PATIENTS Figure 1. Correltion nlysis of the systolic pressure with the levels of serum cysttin C nd substnce P in peripherl blood of ptients in the observtion group. A) A positive correltion ws observed between systolic pressure nd serum cysttin C (r=0.437, P<0.05); B) negtive correltion ws detected between systolic pressure nd the level of substnce P (r= , P<0.05). Discussion Type II DM is kind of metbolic disese with chronic hyperglycemi, in which insufficient secretion of insulin or insulin-resistnce leds to the metbolic disturbnce of nutrients, such s glucose, ft nd protein. Long-term hyperglycemi nd metbolic disturbnce usully result in dmge to multiple orgns, including eyes, kidney, nerve, hert nd vessels (9,10). However, in DM ptients, the risk of crdiovsculr complictions is equivlent to tht of ptients with CAD, nd, thus, similr tretment methods should be dopted to improve the prognosis of crdiovsculr diseses (11,12). DM is usully ccompnied with hypertension, which is key risk fctor for crdiovsculr complictions in DM ptients (13,14). Previous studies reported tht pproximtely 20-60% of DM ptients were lso suffering hypertension, nd 25-50% of hypertension ptients were combined with DM, nd ptients with DM nd hypertension were usully more susceptible to the crdiovsculr diseses (15,16). Rodrigues et l reported tht in DM ptients complicted with hypertension, risk of crdiovsculr complictions ws lmost twice of tht in people without DM or hypertension (17). In this study, we compred the levels of serum cysttin C nd substnce P in peripherl blood between the DM ptients nd DM ptients combined with hypertension for the first time, nd our results suggested the clinicl significnce of serum cysttin C nd substnce P levels in DM nd hypertension. Serum cysttin C, lso known s γ-trce protein, is cysteine proteinse inhibitor widely distributed in tissues nd body fluid (18). Cysttin C in blood cn only be filtrted nd erdicted by glomerulus, nd, thus, cn indicte the chnges in glomerulr filtrtion rte (GFR) (19). Previous studies hve shown tht serum cysttin C is conducive to the evlution of GFR, nd cn increse the detection rte of renl function dmge in erly stge of DM (20-22). Ptients complicted with renl insufficiency, hemturesis or proteinuri were excluded from this study, nd we found tht verge level of serum cysttin C in DM ptients with hypertension ws significntly higher thn tht in control group, suggesting tht serum cysttin C hs significnt predictive vlue for hypertension. Furthermore, we found tht serum level of cysttin C ws higher in DM ptients with grde III hypertension thn in ptients with grde I or II, indicting tht serum cysttin C level is correlted with hypertension. Silv-E-Oliveir et l (23) found tht level of serum cysttin C is correlted with the flow-medited vsodiltion. Bhvsr et l (24) lso found tht serum cysttin C in ptients with pregnncy-induced hypertension syndrome ws significntly higher thn tht in norml control group. Compred with the ptients with only DM, level of serum cysttin C in DM ptients complicted with hypertension ws significntly incresed, suggesting tht those ptients were more susceptible to renl dmge nd refrctory hypertension. As kind of brin-gut peptide, substnce P is not only the neurotrnsmitter or neuromodultor, but lso kind of key chemokine in modulting the immune system nd endocrine system (25). Menzies et l (26) found tht complictions of DM, such s CAD, neuropthic pin or gstrointestinl dysfunction, were correlted with content of substnce P in peripherl blood. Grover et l (27) lso reported tht in type II DM ptients, content of substnce P level in plsm ws significntly lower thn tht in helthy people, nd much lower level ws found in the DM ptients combined with gstroesophgel reflux. Iwski et l (28) found tht in DM ptients, decrese in substnce P level in peripherl blood my be ssocited with the onset of dibetes gstropresis. In ddition, decresed level of substnce P in peripherl blood contributes to the significnt increse in cytokines secreted by immune competent cells nd improvement in bone metbolism. In this study, compred with DM ptients, substnce P level in peripherl blood in DM ptients combined with hypertension ws significntly reduced, which in turn ffect the mjor orgns of ptients, including hert nd lungs. Correltion nlysis lso reveled tht systolic pressure of DM ptients complicted with hypertension ws significntly negtively correlted with substnce P level in peripherl blood (P<0.05). Thus, compred with DM ptients, substnce P level in peripherl blood ws reltively lower, nd blood pressure ws negtively correlted with the substnce P level in peripherl blood of DM ptients complicted with hypertension. In conclusion, we detected the levels of serum cysttin C nd substnce P in peripherl blood of DM ptients complicted with hypertension, nd found tht content of serum cysttin C ws reltively high nd level of substnce P in peripherl blood

5 EXPERIMENTAL AND THERAPEUTIC MEDICINE 16: , ws reltively low in DM ptients with hypertension, nd blood pressure ws positively correlted with the serum cysttin C level nd negtively correlted with the substnce P level in peripherl blood in these ptients. Our findings provided references for further investigtions on the mechnism. Acknowledgements Not pplicble. Funding No funding ws received. Avilbility of dt nd mterils The dtsets used nd/or nlyzed during the present study re vilble from the corresponding uthor on resonble request. Authors' contributions WZ conceived nd designed the study, nd drfted the mnuscript. XG, CL nd JL collected, nlyzed nd interpreted the ptient dt, nd revised the mnuscript criticlly for importnt intellectul content. All uthors red nd pproved the finl mnuscript. Ethics pprovl nd consent to prticipte The study ws pproved by the Ethics Committee of Boji Centrl Hospitl (Boji, Chin). Signed informed consents were obtined from the ptients or the gurdins. 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6 1164 ZHU et l: CORRELATION BETWEEN THE LEVELS OF CYSTATIN C AND SUBSTANCE P IN DM PATIENTS 26. Menzies JR, McKee R nd Corbett AD: Differentil ltertions in tchykinin NK2 receptors in isolted colonic circulr smooth muscle in inflmmtory bowel disese nd idiopthic chronic constiption. Regul Pept 99: , Grover M, Frrugi G, Lurken MS, Bernrd CE, Fussone- Pellegrini MS, Smyrk TC, Prkmn HP, Abell TL, Snpe WJ, Hsler WL, et l: NIDDK Gstropresis Clinicl Reserch Consortium: Cellulr chnges in dibetic nd idiopthic gstropresis. Gstroenterology 140: e8, Iwski H, Kjimur M, Osw S, Knok S, Furut T, Ikum M nd Hishid A: A deficiency of gstric interstitil cells of Cjl ccompnied by decresed expression of neuronl nitric oxide synthse nd substnce P in ptients with type 2 dibetes mellitus. J Gstroenterol 41: , This work is licensed under Cretive Commons Attribution-NonCommercil-NoDerivtives 4.0 Interntionl (CC BY-NC-ND 4.0) License.