2型糖尿病早期肾损伤的实验室指标及其评价

论著2型糖尿病早期肾损伤的实验室指标及其评价

程渝1,侯远文1,杜静2(1.四川省南充中心医院检验科,四川南充637000;2.泸州医学院,

四川泸州646000)

=摘要>目的探讨尿微量清蛋白(M A)、A1微球蛋白(A1M)、转铁蛋白(T Rf)、免疫球蛋白G(IGU)以及血中

肌酐(SCr)和胱抑素C(SCysC)对糖尿病早期肾损伤的诊断价值。方法使用全自动生化分析仪和IM M A EG测定

已确诊的226例2型糖尿病患者尿中M A、A1M、T Rf、IGU以及血中SCr和SCysC,对按尿M A含量分成5个组的

结果进行统计分析并与对照组比较。结果尿M A<19mg/L组,尿A1M含量均值(13.3mg/L)和异常率(22%)

高于对照组,SCysC异常率(11%)高于对照组,差异均有统计学意义(P<0.01);M A21~55mg/L组中M A、A1M、

T Rf的含量均值高于对照组,差异有统计学意义(P<0.01),异常率从大到小分别为M A(100%)>A1M(72%)>

SCy sC(55%)>T R f(26%)>I GU(18%)>SCr(0%),除SCr外均高于对照组,差异有统计学意义(P<0.01);M A

69~150mg/L组M A、A1M、SCy sC的异常率均达到100%,高于SCr异常率(24%),差异有统计学意义(P<0.01)。

结论尿M A、A1M、T Rf、IGU以及血中SCr和SCysC均可反映出不同进程的肾损伤。糖尿病早期肾损伤时,部分

患者肾小管损伤要早于肾小球损伤。尿M A、A1M、SCysC分别是糖尿病患者发生肾小球、肾小管损伤和肾小球滤

过率下降的早期指标。

=关键词>2型糖尿病;肾损伤;肾小球滤过率

DIO:10.3969/j.issn.1672-9455.2010.15.016

中图分类号:R587.2;R446.112文献标志码:A文章编号:1672-9455(2010)15-1567-03

Laboratory indexes and their evaluation of early renal injury in type2diabetes mellitus CH EN G Y u1,H O U Yuan-

w en1,D U J ing2.1.D ep ar tment of L abor ator y,Centr al H os p ital of N anchong City,N anchong,S ichuan637000,

China;2.Luz hou M edical College,Luz hou,S ichuan646000,China

=Abstract>Objective T o study t he v alue of the deter mination of ur inary m1A LB,A1M G,T R F,Scr and Cys C

for diag nosis of ear ly renal disease in t ype2diabetes mellitus.Methods T he ur inary m1A L B,A1M G,T RF,Scr and

Cy s C in226cases o f t ype2diabetes mellitus w ere deter mined w ith auto matic biochemistry analyzer and IM M A EG.

T he results in five g ro ups divided accor ding to ur ina ry micr o-albumin(M A)co ntent wer e analy zed statistically and

co mpar ed w ith those in the contr ol g roups.Results In the gr oup of urinar y M A<19mg/L,the mean value(13.3

mg/L)of urinar y m1A LB co nt ent and the abnor mal rate(22%)wer e higher than those in the co ntr ol g ro up(P<

0.01).T he abnorma l rat e(11%)of Cys C w as hig her than those o f contro l gr oup(P<0.01).T he mean value o f

co nt ent o f the ur ina ry m1A LB,A1M G,T R F in the g ro up o f urinar y M A21-55mg/L wer e all higher than tho se in

the contr ol gr oup(P<0.01).T he abno rmal r ates w ere listed fr om hig h to low as ur inary m1AL B(100%),A1M G

(72%),Cys C(55%),T RF(26%),IG U(18%)and Scr(0%),w hich w ere higher than t ho se in the contr ol g ro up ex-

cept for Scr(P<0.01).T he abno rmal r ate o f m1A LB,A1M G,Cys C in the g ro up of urinar y M A69-150mg/L w ere

100%and hig her than24%of Scr(P<0.01).Conclusion T he m1A LB,A1M G,Cys C,T RF,IG U and Scr all r ef lect

the differ ent pro cesses of the renal injur y.T he renal tubular injury in so me patients is ea rlier than g lo merular injury

at the early stage of DM,ur inary m1A LB,A1M G,Cys C are the ear ly indexes reflecting g lo merular injury,renal tubu-

lar injur y and reductio n o f glomer ular filtr ation r ate respectively.

=Key words>ty pe2diabetes mellitus;r enal injury;g lo merular filt ratio n rate

糖尿病肾病(DN)是糖尿病的常见并发症之一,若能及时检出和早期诊断,可阻断病情向不可逆蛋白阶段发展。尿特定蛋白测定已广泛用于临床,通过测定患者尿中的微量清蛋白(M A)、A1微球蛋白(A1M)、转铁蛋白(T Rf)、免疫球蛋白G (IG U)来诊断和监测早期肾小球或肾小管的损伤。反映肾小球滤过率(G FR)的金标准虽亦确立,但在临床上难以推广。因此临床上普遍用血肌酐(SCr)和内生肌酐清除率(CCr)来评价GFR。近年来较多研究表明血中胱抑素C(SCysC)是一种比SCr、CCr能更灵敏地反映肾小球滤过功能的理想指标。本文通过测定226例糖尿病患者尿中特定蛋白和SCysC及SCr,探讨其在诊断肾小球、肾小管的早期损害和肾小球滤过率下降的价值。

1对象与方法

1.1研究对象试验组:选择2009年1~12月在本院内分泌科门诊和住院的2型糖尿病患者226例(诊断指标符合W HO 的糖尿病诊断标准即空腹血糖大于或等于7.0mmol/L或餐