2型糖尿病早期肾损伤的实验室指标及其评价

Laboratory indexes and their evaluation of early renal injury in type 2 diabetes mellitus

目的探讨尿微量清蛋白(MA)、α1微球蛋白(α1M)、转铁蛋白(TRf)、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IMMAEG测定已确诊的226例2型糖尿病患者尿中MA、α1M、TRf、IGU以及血中SCr和SCysC,对按尿MA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MA<19mg/L组,尿α1M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);MA21～55mg/L组中MA、α1M、TRf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MA(100%)>α1M(72%)>SCysC(55%)>TRf(26%)>IGU(18%)>SCr(0%),除SCr外均高于对照组,差异有统计学意义(P<0.01);MA69～150mg/L组MA、α1M、SCysC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MA、α1M、TRf、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MA、α1M、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。

Objective To study the value of the determination of urinary m1ALB,α1MG,TRF,Scr and Cys C for diagnosis of early renal disease in type 2 diabetes mellitus.Methods The urinary m1ALB,α1MG,TRF,Scr and Cys C in 226 cases of type 2 diabetes mellitus were determined with automatic biochemistry analyzer and IMMAEG.The results in five groups divided according to urinary micro-albumin（MA） content were analyzed statistically and compared with those in the control groups.Results In the group of urinary MA19 mg/L,the mean value（13.3 mg/L） of urinary m1ALB content and the abnormal rate（22%） were higher than those in the control group（P0.01）.The abnormal rate（11%） of Cys C was higher than those of control group（P0.01）.The mean value of content of the urinary m1ALB,α1MG,TRF in the group of urinary MA21-55 mg/L were all higher than those in the control group（P0.01）.The abnormal rates were listed from high to low as urinary m1ALB（100%）,α1MG（72%）,Cys C（55%）,TRF（26%）,IGU（18%） and Scr（0%）,which were higher than those in the control group except for Scr（P0.01）.The abnormal rate of m1ALB,α1MG,Cys C in the group of urinary MA 69-150 mg/L were 100% and higher than 24% of Scr（P0.01）.Conclusion The m1ALB,α1MG,Cys C,TRF,IGU and Scr all reflect the different processes of the renal injury.The renal tubular injury in some patients is earlier than glomerular injury at the early stage of DM,urinary m1ALB,α1MG,Cys C are the early indexes reflecting glomerular injury,renal tubular injury and reduction of glomerular filtration rate respectively.