血和尿Ⅳ型胶原对早期糖尿病肾病诊断的意义

The significance of blood and urinary Ⅳ type collagen in early diagnosis of diabetic nephropathy

目的：探讨血和尿Ⅳ型胶原（ⅣＣ）含量在非胰岛素依赖型糖尿病（ＮＩＤＤＭ）中的变化及对肾功能损害早期诊断的价值。方法：采用酶联免疫法和放射免疫法测定３３例病史５年以上、血尿素氮（ＢＵＮ）和肌酐（ＳＣｒ）均在正常范围内的ＮＩＤＤＭ患者（糖尿病组）和３０例非糖尿病患者（对照组）血和尿中ⅣＣ含量及尿微量白蛋白（ＵＡ）含量，比较２组患者上述各项指标及检测阳性率。结果：糖尿病患者血和尿中ⅣＣ阳性率（分别为７８．７９％和１００．００％）及其含量〔血ⅣＣ（１６０．２０±６６．０１）μｇ／Ｌ，尿ⅣＣ（６７．３５±８．３１）μｇ／Ｌ）〕均明显高于对照组〔分别为１０．００％、６．６７％、（６１．７８±２９．２６）μｇ／Ｌ和（２．２６±２．３６）μｇ／Ｌ〕，Ｐ均＜０．０１。且糖尿病患者尿ⅣＣ检测阳性率（１００．００％）明显高于尿微量白蛋白检测阳性率（１８．１８％，Ｐ＜０．０１），其含量变化二者呈明显正相关（ｒ＝０．８９２４，Ｐ＜０．０１）。结论：测定糖尿病患者血、尿ⅣＣ，尤其是尿ⅣＣ较尿ＵＡ测定对ＤＮ更具早期诊断价值；ⅣＣ是早期糖尿病肾损害的预警指标之一。

Objective:To investigate changes in blood and urine Ⅳ type collagen (ⅣC) concentrations and its diagnostic value for early renal damage in patients with noninsulin dependent diabetes mellitus (NIDDM).Methods:The concentrations of blood or urine ⅣC and urinary microalbuminuria (UA) were measured in 33 NIDDM cases (diabetes group) who had diabetes longer than 5 years and the levels of blood urea nitrogen and creatinine were in noraml range,and 32 cases without NIDDM (control group) by radioimmunoassay and enzyme linked immunoabsorbent assay (ELISA).All the indices and the positive rate measured between two groups were compared.Results:Both the positive rate (blood:78 79%;urine:100 00%) and concentrations of blood and urine ⅣC blood :(160 20±66 01)μg/L;urine:(67 35±8 31)μg/L in diabetes group were significantly higher than those in control group positive rate:10 00% and 6 67%;ⅣC:(61 78±29 26)μg/L and (2 26±2 36)μg/L,all P <0 01 .In diabetes patients the positive rate of urinary ⅣC (100 00%) was significantly higher than that of UA (18 18%, P <0 01) and the variations of concentrations showed a positive correlation ( r =0 892 4, P <0 01).Conclusions:In patients with diabetes the measurement of blood and urine ⅣC ,especially urine ⅣC,is much more valuable than that of urinary UA for the early diagnosis of diabetic nephropathy.The ⅣC is one of predictive indices for early diabetic renal damage.