糖尿病患者不同时间尿微量蛋白排泄量的比较

COMPARISON OF URINARY PROTEIN EXCRETION COLLECTED AT DIFFERENT TIMES

为研究和比较不同时间尿液中微量蛋白排泄情况，选择３０例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者，分别收集２４ｈ尿、白天尿、夜间尿、随意尿和定时尿以测定白蛋白（Ａｌｂ）／肌酐（Ｃｒ），转铁蛋白（ＴＲＦ）／ＣＲ，Ｎ－乙酰－Ｂ、Ｄ－氨基葡萄糖苷酶（ＵＡＧ）／Ｃｒ，视黄醇结合蛋白（ＲＢＰ）／Ｃｒ。在２４ｈ尿测定中，高于正常例数从高到低依次为ＴＲＦ／Ｃｒ，ＮＡＧ／Ｃｒ，Ａｌｂ／Ｃｒ，ＲＢＰ／Ｃｒ，故认为ＴＲＦ／Ｃｒ较Ａｌｂ／Ｃｒ敏感，ＮＡＧ出现可较ＴＲＦ和Ａｌｂ早，在正常Ａｌｂ／Ｃｒ，ＴＲＦ／Ｃｒ组，Ａｌｂ／Ｃｒ，ＴＲＦ／Ｃｒ受体位改变影响，而在异常组却无此现象发生，ＮＡＧ／Ｃｒ，ＲＢＰ／Ｃｒ不受体位影响。水负荷对尿微量蛋白排泄无影响，随意尿与２４ｈ尿无显著性差别，可用于普查：白天尿Ａｌｂ／Ｃｒ和ＴＲＦ／Ｃｒ，敏感性高，可用于筛选；夜间尿特异性高，可用于明确诊断。夜间尿ＮＡＧ／Ｃｒ，ＲＢＰ／Ｃｒ的敏感性和特异性均较高，是很好的检测方法。

To assess the usefulness of urinary protein(Alb/Cr,TRF/Cr,RBP/Cr,WAG/Cr)excretion obtained with different time collections,30 cases of NIDDM patients were selected.Daytime urine.overnight urine,random urine,timed urine and 24h urine were collected for measurement of Alb/Cr,TRF/Cr,RBP/Cr,NAG Cr.Among the 30 cases whose 24h urine was measured,15 cases with elevated/Alb/Cr,19 cares with enhanced TRF/Cr,18 eases with increased NAG/Cr.For esrly diagnosis of diabetic nephropathy,TRF/Cr must be more sensitive than Alb/Cr,NAG/Cr might be more sensitive than Alb/Cr.In normal Alb/Cr,TRF/Cr group,Alb/Cr and TRF/Cr were influenced by change of posture.This kind of difference could not be seen in elevated group. Posture change had no influence on NAG/Cr and RBP/Cr.Water loading had no effect on urinary protein excretion.There was no significant differenee between 24h and random urine protein excretion,so random urine could be used for medical survey, The daytime urine with high sensitivity was good for scree and overnight urine with high specificity was good for confirming diagnosis.Overnight urine NAG/Cr and RBP/Cr were good test too.