Correlation analysis between urinary albumin-to-creatinine ratio and amino acid metabolism in patients with type 2 diabetes mellitus

Fu Miao; Cai Mengjie; Li Yangyang; Yang Xuerong; Tao Lewei; Chen Qingguang; Lu Hao; Hou Ruifang; Zhao Jindong

doi:10.3760/j.issn.1673-4777.2026.03.013

Abstract：Objective To investigate the relationship between urinary albumin-to-creatinine ratio(UACR)and amino acid metabolism in patients with type 2 diabetes mellitus(T2DM).Methods A total of 117 T2DM patients admitted to the Department of Endocrinology,Shuguang Hospital Affiliated to Shanghai University of Chinese Medicine from January to November 2021 were enrolled as research subjects.According to the UACR test results,the patients were divided into three groups:normal group(UACR≤30 mg/g,44 cases),microalbuminuria group(30 mg/g＜UACR ≤ 300 mg/g,41 cases),and macroalbuminuria group(UACR＞300 mg/g,32 cases).The general data and biochemical indicators of the three groups were compared.Spearman correlation analysis and multivariate Logistic regression analysis were used to analyze the relationship between UACR level and amino acid metabolism.Receiver operating characteristic(ROC)curve was used to evaluate the relationship between amino acids and UACR levels in each group.Results There were no significant differences in gender and age among the three groups(x2=3.011,P=0.222;Z=2.261,P=0.323).The difference in disease duration among the three groups was statistically significant(Z=34.356,P＜0.001).The levels of serum creatinine and blood urea nitrogen in the macroalbuminuria group were higher than those in the microalbuminuria group and the normal group,while the estimated glomerular filtration rate was lower than that in the microalbuminuria group and the normal group(all P＜0.05).There were significant differences in the levels of lysine,proline,threonine,citrulline,tyrosine and valine among the three groups(all P＜0.05).Spearman correlation analysis showed that UACR level was negatively correlated with the metabolic levels of lysine,threonine,tyrosine and valine(r=-0.215,-0.226,-0.363,-0.221,all P＜0.05),and positively correlated with the metabolic level of citrulline(r=0.424,P＜0.001).Multivariate Logistic regression analysis showed that high citrulline metabolic level was an influencing factor for the increase of UACR level(P＜0.001).ROC curve analysis showed that the area under the curve of citrulline in predicting the increase of UACR was 0.782(95％confidence interval:0.675-0.890,P＜0.001),with the optimal cut-off value of 40.615 μmol/L,sensitivity of 75.0％and specificity of 82.4％.Conclusion Serum citrulline is a sensitive marker for the increase of UACR in T2DM patients,which can well predict and evaluate the occurrence of diabetic nephropathy.