尿微量蛋白在早期糖尿病肾病中的诊断意义

The value of detection of urinary micro-protein in the early diagnosis of diabetic nephropathy

目的探讨尿微量白蛋白(MA)、尿转铁蛋白(TRF)、尿β2-微球蛋白(β2-MG)和尿α1-微球蛋白(α1-MG)在糖尿病肾病早期诊断中的意义。方法采用免疫比浊法测定82例2型糖尿病患者及80名健康人24h尿中MA、TRF、β2-MG、α1-MG含量,比较四者在糖尿病肾病筛选中的价值。结果糖尿病病程小于5年组,尿24hα1-MG、β2-MG含量与健康对照组相比明显增加;糖尿病病程5～10年组,尿24hMA、TRF、β2-MG和α1-MG含量与健康对照组相比明显增加;在尿微量白蛋白正常的糖尿病患者中,尿24hTRF、β2-MG和α1-MG含量增高的百分比分别为29.23%,50.77%,61.54%。结论糖尿病肾病早期肾小球和肾小管都有-定程度的损害,尿TRF、β2-MG和α1-MG较尿MA出现更早,测定尿TRF较尿MA更敏感,测定尿TRF、α1-MG、β2-MG和MA,有助于全面评估糖尿病肾病(DN)的肾损害,早期诊断DN。

Aim To evaluate the value of the urinary microalbumin（MA）,urinary transferrin（TRF）,urinaryβ2- microglobulin（β2-MG）and urinaryα1-microglobulin（α1-MG）in the early diagnosis of diabetic nephropathy.Methods The concentrations of urinary MA,TRF,β2-MG andα1-MG excretion in 24vhours 82 diabetic patients and 80 normal subjects as control group were measured by immune turbidity method.Results The concentratins of 24-hours urinaryα1-MG,β2-MG in diabetes group of less than 5 years duration were significantly increased compared with healthy control group;that of 24-hours urinary MA,TRF,β2-MG andα1-MG in diabetes group of 5～10 years duration were significandy increased compared with in diabetes group of less than 5 years duration.in the normal urinary albumin group of diabetic patients,the increased percentage of urine TRF,β2-MG andα1-MG were respectively 29.23%,50.77%,61.54%. Conclusions In early diabetic nephropathy,glomeruli and tubules have a certain degree of damage.Urine TRF,β2-MG andα1-MG appeared earlier than urine MA.Urine TRF was more sensitive than the urine MA,24 hours urine TRF,α1- MG,β2-MG and MA excetion amount may be conductive to eveluate the renal damage in DM and to diagnose diabetic nephropathy early.