BACKGROUND Oxidative stress may play an important role in the development of diabetic complications. The ratio of human nonmercaptalbumin (HNA; oxidized form) to human mercaptalbumin (HMA; reduced form) has attracted attention as an indicator for systemic redox states. In this study, we measured the ratio in elderly patients with diabetes and evaluated its association with diabetic complications and disability in activities of daily living (ADL disability). METHODS One hundred twenty-six elderly patients with diabetes, aged 70 years and older, under medical care at Yukuhashi Central Hospital from April 2018 to June 2018, were continuously recruited. HNA%, defined as HNA / (HNA + HMA) × 100, was measured by a high-performance liquid chromatography method. First, multivariate regression analysis was performed to evaluate which variables were significant determinants for HNA%. Next, to evaluate the association of HNA% with ADL disability, logistic regression analysis in various models was performed. Then we plotted the receiver operating characteristic (ROC) curve and calculated the under area the curve (AUC), sensitivity, and specificity in each model. RESULTS In elderly patients with diabetes, multiple regression analysis showed that serum bilirubin levels and albumin levels, both of which are major endogenous anti-oxidants, and chronic renal failure (or proliferative nephropathy) were significantly associated with HNA%, suggesting that HNA% may be a good biomarker for oxidative stress in those patients. We then evaluated the association of HNA% with ADL disability in various logistic regression models. Model using only HNA% showed that it was a significant determinant for ADL disability (OR 1.158, 95% CI 1.077-1.244, P < 0.001). Model using HNA% and age showed that both variables were significant determinants for ADL disability (OR 1.160, 95% CI 1.069-1.258, P < 0.001; OR 1.258, 95% CI 1.110-1.427, P < 0.001, respectively). ROC analysis showed that the AUC of HNA% alone was 0.765. The AUC of model using HNA% and age was further increased to 0.866. CONCLUSIONS HNA% was significantly associated with diabetic complications and ADL disability, thereby may be clinically useful as an oxidative stress marker in elderly patients with diabetes.

中文翻译：

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人血清非巯基白蛋白与巯基白蛋白之比作为糖尿病老年患者糖尿病并发症和日常生活活动能力丧失的生物标志物的临床实用性。

背景技术氧化应激可能在糖尿病并发症的发展中起重要作用。人非巯基白蛋白（HNA；氧化形式）与人巯基白蛋白（HMA；还原形式）之比作为系统性氧化还原状态的指标已引起关注。在这项研究中，我们测量了老年糖尿病患者的比率，并评估了其与糖尿病并发症和日常生活活动能力障碍（ADL障碍）的关系。方法自2018年4月至2018年6月，在Yukuhashi中央医院接受医疗护理的126名年龄在70岁及以上的老年糖尿病患者被连续招募。通过高效液相色谱法测量HNA％，其定义为HNA /（HNA + HMA）×100。第一的，进行多元回归分析以评估哪些变量是HNA％的重要决定因素。接下来，为了评估HNA％与ADL残疾的关联，在各种模型中进行了逻辑回归分析。然后，我们绘制了接收器工作特性（ROC）曲线，并计算了每种模型下的曲线下面积（AUC），灵敏度和特异性。结果在老年糖尿病患者中，多元回归分析表明，血清胆红素水平和白蛋白水平都是主要的内源性抗氧化剂，而慢性肾功能衰竭（或增生性肾病）与HNA％显着相关，提示HNA％可能与HNA％显着相关。在这些患者中成为氧化应激的良好生物标志物。然后，我们在各种逻辑回归模型中评估了HNA％与ADL残疾的关联。仅使用HNA％的模型显示，它是ADL残疾的重要决定因素（OR 1.158，95％CI 1.077-1.244，P <0.001）。使用HNA％和年龄的模型表明，这两个变量都是ADL残疾的重要决定因素（分别为OR 1.160，95％CI 1.069-1.258，P <0.001; OR 1.258，95％CI 1.110-1.427，P <0.001）。ROC分析显示，仅HNA％的AUC为0.765。使用HNA％和年龄的模型的AUC进一步增加到0.866。结论HNA％与糖尿病并发症和ADL残疾显着相关，因此在临床上可用作老年糖尿病患者的氧化应激指标。使用HNA％和年龄的模型表明，这两个变量都是ADL残疾的重要决定因素（分别为OR 1.160，95％CI 1.069-1.258，P <0.001; OR 1.258，95％CI 1.110-1.427，P <0.001）。ROC分析显示，仅HNA％的AUC为0.765。使用HNA％和年龄的模型的AUC进一步增加到0.866。结论HNA％与糖尿病并发症和ADL残疾显着相关，因此在临床上可用作老年糖尿病患者的氧化应激指标。使用HNA％和年龄的模型表明，这两个变量都是ADL残疾的重要决定因素（分别为OR 1.160，95％CI 1.069-1.258，P <0.001; OR 1.258，95％CI 1.110-1.427，P <0.001）。ROC分析显示，仅HNA％的AUC为0.765。使用HNA％和年龄的模型的AUC进一步增加到0.866。结论HNA％与糖尿病并发症和ADL残疾显着相关，因此在临床上可用作老年糖尿病患者的氧化应激指标。