DM2患者GFR、尿Alb和尿Alb/尿Cr测定及其临床意义

Clinical Significance of Determination of GFR,Urinary Albumin and UAlb/UCr in Patients with Type 2 Diabetes

目的:探讨多项指标检测对糖尿病肾病(DN)早期诊断的价值。方法:采用99Tcm-DTPA(99Tcm标记的二乙三胺五乙酸)肾动态显象法及放射免疫分析125例2型糖尿病(DM2)患者的肾小球滤过率(GFR),24h尿白蛋白、尿肌酐、尿微量白蛋白/尿肌酐(UAlb/UCr)。结果:DN病程<5年组患者GFR、UAlb/UCr明显高于DM无肾病组,且随着病程的延长,GFR逐渐降低,UAlb/UCr逐渐增高,差异有统计学意义;GFR与病程、体重指数、尿Alb/UCr比值呈明显负相关(r分别为-0.691、-0.631、-0.698,P<0.01)。结论:GFR能够反映DN早期高滤过,且能反映肾脏损伤的程度,尿UAlb/UCr比值较24hUAlb测定能够更早期灵敏的反映早期糖尿病肾损害。早期采用GFR和UAlb/UCr比联检对DN的早期诊断、治疗、预后判断有一定的临床价值。

Objective To study the diagnostic value of determination of glomerular filtration rate（GFR）,Urinary albumin （UAlb） and UAlb/UCr for early diabetic nephropathy in patients with type 2 Diabetes. Methods UAlb,UAlb/UCr were measured with radioimmunoassay （RIA） and GFR measured with Tcm DTPA dynamic renal imaging in 102 DM2 patients with diabetic nephropathy （DN） and 23 DM2 patients without nephropathy. Results In diabetics with nephropathy with a disease course of less than five years （n=38）,the GFR,UAlb/UCr were significantly higher than those in diabetics without nephropathy. With prolongation of the disease,GFR gradually declined and UAlb/UCr rose furthur and in patients with nephropathy with disease courses over 10 years,the GFR was significantly lower and UAlb/UCr significantly higher than those in diabetics without nephropathy （all P0.05）. The GFR was negatively correlated with course of disease,BMI and UAlb/UCr （r=-0.691,-0.631,-0.698,respectively,P0.01）. Conclusion GFR can reflect the degree of renal damage of diabetic patients,and may be helpful for evaluation of progression of DN when combined with assay of albuminuria.