2型糖尿病患者肾小管间质改变的临床研究

Clinical study of the tubulointerstitial change in patients with type 2 diabetes mellitus

目的:通过检测尿N乙酰βD葡萄糖苷酶(NAG)、视黄醇结合蛋白(RBP)及禁水13h尿渗透浓度,评估2型糖尿病(DM)患者肾小管间质功能的改变,并探讨其机制。方法:2型DM患者77例,根据24h尿清蛋白排泌量将其分为DMⅠ组(尿清蛋白<30mg)、DMⅡ组(尿清蛋白30～300mg)和DMⅢ组(尿清蛋白>300mg),观察各组之间尿NAG、RBP和尿渗透浓度变化的差异以及DM的病程、血糖控制指标糖化血红蛋白(HbA1c)水平与各变量之间的关系。结果:2型DM患者均有不同程度的尿NAG、RBP增高,尿渗透浓度减低;随尿清蛋白排泌量的增加,尿NAG、RBP明显增高,其增高的程度与尿清蛋白排泌量呈密切的平行关系;病程长、血糖控制较差者尿NAG、RBP异常率明显高于病程较短、病情控制较好者(P<0.05)。结论:糖尿病肾病(DN)较普遍地存在肾小管间质受损。严格控制血糖,纠正代谢紊乱,加强DN标记物的检测,对DN早期诊断和干预有重要意义。

Objective: To investigate tubulointerstitial damage in patients with type 2 diabetes mellitus (DM) by detecting urinary-N-acetyl-beta-D-glucosaminidase (NAG) levels, urinary retinol-binding protein (RBP) levels and osmolality after 13 h water-fasting. Methods: Seventy-seven patients with DM were divided into three groups according excretion of 24 hours urinary albumin: DMⅠ group (urinary albumin <30 mg), DMⅡ group (urinary albumin 30-300 mg), DMⅢ group (urinary albumin >300 mg), to compare the differences of urinary NAG, RBP and osmolality in each groups; and to observe the relation of the duration of diabetes and the level of HbA 1c with these parameters. Results: Urinary NAG and RBP increased in urinary but urinary osmolality decreased in all patients. The increase of urinary NAG and RBP were also paralleled with the increase of urinary albumin excretion, and there was a remarkable relation between the urinary NAG, RBP and albumin. The urinary levels of NAG, RBP were much higher in cases with long diabetes history and poor glycaemic control than those with short diabetes history and good glycaemic control. Conclusion: There were tubulointerstital damages in early stages of diabetic nephropathy. These findings suggested that good glycemic control, metabolism disturbance correction and detection of markers of diabetic nephropathy are important in early diagnosis and treatment.