红细胞钠-锂逆向转运活性与糖尿病肾病关系的研究

Erythrocyte sodium lithium countertransport and diabetic nephropathy

目的 探讨红细胞钠锂逆向转运（ Ｓ Ｌ Ｃ） 活性在糖尿病肾病（ Ｄ Ｎ） 发病中的作用及其对 Ｄ Ｎ 的预测价值。方法 采用 Ｚｅｒｂｉｎｉ 最新提出的６００ ｍ ｍｏｌ／ Ｌ 法，测定正常对照２４ 例、原发性高血压２６ 例及２ 型糖尿病８５ 例 Ｓ Ｌ Ｃ 活性。糖尿病组按尿白蛋白／ 肌酐比值分为正常、微量和大量白蛋白尿组。结果 原发性高血压组（ Ｐ＜ ０ ．００１） 和糖尿病组（ Ｐ＜ ０ ．００１） Ｓ Ｌ Ｃ 活性明显高于正常对照组，微量白蛋白尿组（ Ｐ＜ ０ ．０１） 和大量白蛋白尿组（ Ｐ＜ ０ ．００５） Ｓ Ｌ Ｃ 活性明显高于正常白蛋白尿组。多元线性逐步回归分析显示 Ｓ Ｌ Ｃ 活性、病程、平均血压、甘油三酯为尿白蛋白／ 肌酐比值升高的独立危险因素。结论 Ｓ Ｌ Ｃ 活性增高是糖尿病肾病发生的主要危险因素之一，可作为糖尿病肾病的易感指标，有一定的预测价值，但缺乏特异性和敏感性。

Objective To explore theeffectoferythrocytesodium lithium countertransport (SLC) activity in the susceptibility of diabetic nephropathy. Methods Erythrocyte sodium lithium countertransport activities in 24 healthy volunteers, 26 patients with essential hypertension and 85 patients with type 2 diabetes mellitus weremeasuredwithnew600mmol/Lprocedure advanced by Zerbini. The diabetic patients were divided by urinary albumin creatinine ratio(ACR)into normoalbuminuria group (ACR<2.5mg/mmol), microalbuminuria group (ACR between 2.5～25mg/mmol) and macroalbuminuria group (ACR>25mg/mmol). Results Sodium lithium countertransport activities wereelevatedinessentialhypertension group (0.4467±0.1994mmol·L RBC -1 ·hr -1 ,P<0.001) and diabetes group (0.4159±0.1624mmol·L RBC -1 ·hr -1 ,P<0.001) as compared with normal control group (0.2885±0.0987mmol·L RBC -1 ·hr -1 ). Activities were also higher in microalbuminuria group (0.4589±0.1517mmol·L RBC -1 ·hr -1 ,P<0.01) and macro albuminuria group(0.4858±0.1319mmol·L RBC -1 ·hr -1 ,P<0.005)thaninnormoalbuminuriagroup(0.3479±0.1617mmol·L RBC -1 ·hr -1 ). Multiple stepwise regression analyses showed that SLC, duration of diabetes, mean blood pressure and triglyceride were the independent risk factors of elevated urinary albumin creatinine ratio. Conclusion Elevatedsodium lithiumcountertransportactivityisone of the risk factors of diabetic nephropathy. Thus, SLC activity can serve as a marker for susceptibility of diabetic nephropathy. It has some prediction value, but lacks specificity and sensibility.