2型糖尿病肾病患者尿Ⅳ型胶原和层粘连蛋白测定的临床意义

Clinical significance of urinary type Ⅳ collagen and laminin determination

目的应用受试者工作特征曲线(ROC)评价尿Ⅳ型胶原和尿层粘连蛋白(LN)在糖尿病肾病(DN)监测中的临床价值。方法 143例病程大于5年的T2DM患者和103名正常对照用放射免疫法测定晨尿Ⅳ型胶原和尿LN水平,分析正常白蛋白尿的T2DM患者尿Ⅳ型胶原和尿LN的变化和ROC曲线下面积等。结果正常尿白蛋白组和微量尿白蛋白组的T2DM患者晨尿Ⅳ型胶原和尿LN水平均显著高于正常对照组(P<0.05);尿Ⅳ型胶原>18.9 ng/mL和尿LN>130.33 ng/mL为正常参考范围上限;正常尿白蛋白的T2DM患者以晨尿Alb=16 mg/L为分界值时,尿Ⅳ型胶原曲线下面积(0.749)超过Alb/Cr面积(0.698)、尿Ⅳ型胶原和尿LN水平有显著变化(P<0.05)。结论病程大于5年的正常尿白蛋白T2DM患者晨尿Ⅳ型胶原>18.9 ng/ml或和尿LN>130.33 ng/ml时,应高度怀疑早期DN。

Objective To evaluate the role of urinary type Ⅳ collagen and urinary laminin LN（LN） in screening diabetic nephropathy. Methods The urinary levels of Ⅳ and LN were measured by radioimmunoassay （RIA） in 143 cases with type 2 diabetes mellitus （T2DM） with the course over 5 years and in 103 normal controls （NC）. The sensitivity and specificity of urinary IV and LN, UAlb/cre and urinary creatinine for diabetic nephropathy diagnosis were calculated and ROC curve was drawed. The area under curve of ROC of urinary Ⅳ and LN was compared with that of Alb/Cr in normal urinary albumin group of T2DM. Results The levels of Ⅳ and LN in group A（Alb/Cr〈30mg/g） and group B（Alb/Cr 30- 300 mg/g） were significantly higher than those in NC（P〈0.05）. The upper limit for the nomal referance of IV and LN were 18.9 ng/mL and 130.33 ng/mL respectively. In A group,AUCⅣ, （0. 749） was larger than AUCAlb/cr（0. 698） when Alb of 16 mg/L was a cut point. Conclusions The level of urinary IV and LN is a useful marker in screening DN. The urinaryⅣ〉18.9 ng/ml and/or LN〉130.2,3 ng/mL in T2DM course beyond 5 years may be an indicator for DN.