糖尿病患者尿蛋白监测方法的探讨和临床评价

Evaluation of Urine Protein Monitoring in Diabetics

本文对监测 DM 患者尿蛋白的4种方法和6项指标进行了临床评定。结果表明:IRIE 法24h UAIb 定量和随意尿 UAIb/UCr 指数最敏感,阳性率可达64.4%(56/87)和58.6%(51/87),依次为 UTP/UCr 指数40.2%(35/87)、CBB 法24h UTP 定量35.6%(31/87)、RIA 法 Uβ_(2m)/24h 定量32.3%(19/59),最低为试纸法尿蛋白定性检测28.7%(25/87)。UAIb/24h 定量与 UAIb/UCr 呈高度相关,阳性率无显著差异(P>0.05)。56例尿总蛋白正常(≤106.2mg/24h)的 DM 患者,用试纸法检测全为阴性,UTP/UCr 指数为5例阳性(8.9%),而UAIb/24h 定量和 UAIb/UCr 指数阳性率仍分别达48.3%(27/56)和39.3%(22/56)。结果提示 DM 肾病患者早期蛋白尿系以尿白蛋白为主,许多患者在尿总蛋白并未升高时,尿白蛋白即已升高,因而更具临床价值;IRIE 法24hUAIb 定量和随意尿 UAIb/UCr 指数是理想的监测手段和指标,后者更实用;而实检室常规试用的蛋白试纸,可靠性最低。

Four methods and six parameters in determination of urinary protein in diabeticpatients were clinically evaluated.The four methods were:(1)Coomassie Brilliant Blue G250 assay (CBB) for quan-titative measurement of total urine protein, (2)improved rocket immunoelectropho-resis (IRIE) for albumin in urine, (3)radioimmunoassay (RIA) for β_2-microglobulinin urine, (4)protein test paper assay (Albustix) for semiquantitative test of proteinin random urine (SQT). The six parameters were: (1)SQT, (2)UTP/24h and (3)UAIb/24h or (4)Uβ_2m/24h(i.e. total protein and albumin or β_2-microglobulin amount in 24-hour urine), (5)UTP/UCr and (6)UAIb/UCr (i.e. total protein and albumin creatinine index num-ber in random urine).The data showed that the most sensitive parameters were UAIb/24h and UAIb/UCr, their positivity rates being 64.4% (56/87) and 58.6% (51/87) respectively; thenthe next three were UTP/UCr (40.2%, 35/87), UTP/24h (35.6%, 31/87), Uβ_2m/24h(32.3%, 19/59); the most insensitive parameter was SQT (28.7%, 25/87). There was aclose correlation between UAIb/24h and UAIb/UCr (r=0.966, P<0.01), the two posi-tivity rates not significantly different (P>0.05). In 56 diabetics the UTP/24h levelwas normal, all SQT results were negative and UTP/UCr was positive in only 5cases (8.9%); however, the positivity rates of UAIb/24h and UAIb/UCr were 48.2%(27/56) and 39.3% (22/56), respectively. The results suggested that the urinary pro-tein excreted was mainly albumin in early diabetic nephropathy; the urinary totalprotein level was normal, but urinary albumin level abnormal in most of the patients;UAIb/24h and UAIb/UCr were ideal parameters for early diagnosis of diabetic ne-phropathy, of the two the latter was far better practically than the former. The re-sult of Albustix was less reliable.