尿GGT、尿mAlb及血清CysC与2型糖尿病早期肾损伤的关系

The relationship between urine γ-glutamyltransferase,urine microalbumin and serum cystatin C with early kidney injury of type 2 diabetes mellitus

目的观察2型糖尿病(DM)患者尿γ-谷氨酰基转移酶(GGT)、尿微量白蛋白(mAlb)、尿肌酐(UCr)、血清半胱氨酸蛋白酶抑制剂C(Cys C)与糖尿病肾病早期肾损伤的关系。方法收集179例2型DM患者晨尿,检测尿mAlb、UCr、GGT,同时测定空腹血糖(FPG)、血清肌酐(SCr)、Cys C、糖化血红蛋白(HbA1c)及餐后2 h血糖(Glu2h)。以尿mAlb水平将2型DM患者分为尿mAlb阴性组、mAlb尿组及尿蛋白(UP)阳性组。分析27例2型DM患者在治疗前后的尿GGT浓度变化。结果以mAlb水平分组:72例尿mAlb阴性组、68例mAlb尿组与39例UP阳性组的尿GGT浓度分别为33.3、47.3、26.0 U/L(P=0.000),Cys C分别为0.85、1.04、2.16 mg/L。以UCr校正尿mAlb(以mAlb/UCr比值)后分组:mAlb尿组的尿GGT水平(37.1 U/L)与尿mAlb阴性组(34.65 U/L)比较无差异,UP阳性组的尿GGT水平(19.8 U/L)明显低于尿mAlb阴性组(P<0.01)。尿GGT与Cys C、SCr呈显著负相关(r=-0.723、P=0.002;r=-0.440、P=0.006)。27例2型DM患者治疗前后比较,17例血糖、mAlb明显改善患者治疗前尿GGT水平(56.6 U/L)明显高于治疗后(33.7 U/L)(P=0.012),而疗效不佳的10例患者尿GGT持续增高,治疗前为37.65 U/L,治疗后为52.65 U/L(P=0.004)。结论2型DM早期mAlb尿时,尿GGT水平可能升高,但随着蛋白尿的加重,肾脏损伤发生不可逆的改变时,尿GGT水平持续下降。尿GGT水平与Cys C呈负相关,且随mAlb的变化而变化,可以作为辅助诊断糖尿病早期肾损伤与疾病治疗监测的指标之一。

Objective To observe the relationship among urine γ-glutamyltransferase（GGT）,urine microalbumin,urine creatinine（UCr） and serum cystatin C（Cys C） in early kidney injury of type 2 diabetes mellitus（DM） patients.Methods 179 type 2 DM patients were classified into negative urine microalbumin group,urine microalbumin group and positive urine protein（UP） group according to their microalbumin levels.Their microalbumin,UCr and GGT levels of morning urine were determined,and their fasting plasma glucose（FPG）,serum creatinine（SCr）,Cys C,glycosylated hemoglobin and glucose 2 hours after meal（Glu2h） were determined.The GGT activity in 27 type 2 DM patients was observed before and after their treatments.Results Considered by microalbumin level,72 negative urine microalbumin,68 urine microalbumin and 39 positive UP patients had their different urine GGT activities of 33.3,47.3 and 26.0 U/L（P=0.000） and their Cys C concentrations of 0.85,1.04 and 2.16 mg/L,respectively.Urine microalbumin was corrected by UCr and classified by microalbumin/UCr ratio,and there was no difference of urine GGT between urine microalbumin group（37.1 U/L） and negative urine microalbumin group（34.65 U/L）,but the urine GGT in the positive UP group（19.8 U/L）was lower than that in the negative urine microalbumin group（P〈0.01）.Urine GGT level correlated negatively with serum Cys C and SCr（r=-0.723,P=0.002 and r=-0.440,P=0.006）.In 17 type 2 DM patients of improved glucose and microalbumin levels,their urine GGT activities of before and after treatment were 56.6 U/L and 33.7 U/L（P=0.012）.10 inefficacious DM patients＇ urine GGT activities were increasing and were 37.65 U/L and 52.65 U/L before and after treatment（P=0.004）.Conclusions Early microalbumin type 2 DM patients may have higher urine GGT activity,and it will be lower if the reversed injury becomes worse.Urine GGT activity correlates negatively with Cys C and has the relationship with microalbumin,which may be an diagnosis indicator of early kidney injury of DM.