2型糖尿病肾病患者脂蛋白(a)的临床应用价值探讨

Clinical application value of lipoprotein(a) in patients with type 2 diabetic nephropathy

目的探讨24h-UAER、Lp(a)对2型糖尿病肾病早期诊断的临床应用价值。方法选取糖尿病患者329例,根据尿蛋白实验阳性程度分为4组,采用免疫透射比浊法分别定量检测24h-UAER、Lp(a),对两定量指标进行相关分析,并与健康对照组比较。结果方差分析显示,各组24h-UAER、Lp(a)水平均不同(P<0.01),糖尿病患者各组均高于健康对照组。经q检验显示,尿蛋白阴性组与健康对照组比较,Lp(a)水平差异无统计学意义(P>0.05),24h-UAER水平差异有统计学意义(P<0.01);尿蛋白阳性病例Lp(a)与24h-UAER呈正相关,相关性较好;Lp(a)水平高于正常参考值上限的检出率,尿蛋白阴性组和尿蛋白±～+组分别为11.4%和18.7%,与健康对照组比较差异无统计学意义(P>0.05);尿蛋白++组、尿蛋白+++以上组分别为55.0%和80.2%,与健康对照组比较差异有统计学意义(P<0.05,P<0.01)。结论 Lp(a)可作为2型糖尿病早期肾损害的实验性指标,对糖尿病肾病早期诊断和防治具有现实的指导意义和临床应用价值。

Objective To investigate the clinical value of 24 h-UAER and Lp（a） for the early diagnosis of type 2 diabetic nephropathy.Methods 329 cases of patients with diabetes mellitus（DM） were divided into 4 groups according to the positive degree of urine protein test,and 24 h-UAER and Lp（a） were measured for all groups by immune turbidimetry.The two quantitative indexes were analyzed for correlation and compared with healthy controls （control group）.Results Variance analysis indicated that the 24 h-UAER and Lp（a） levels of those group were different（P0.01） and those in all DM groups were higher than control group.According to q test,there was no difference of Lp（a） level between urinary protein negative group and control group （P0.05）,but the difference of 24 h-UAER was statistically significant（P0.01）.In urinary protein positive group,Lp （a） and 24 h-UAER were positively correlated with fine correlativity.The detection rate of Lp（a）,higher than normal upper limit,of urinary protein negative group and urinary protein±- ＋ group were 11.4% and 18.7%,without significant difference with control group（P0.05）,of urinary protein ＋ ＋ group and ＋ ＋ ＋ and upper group were 55.0% and 80.2%,respectively,with significant difference with control group（P0.05,P0.01）.Conclusion Lp（a） could be used as a experimental index for the diagnosis of type 2 diabetic kidney injury,with clinical application value for the diagnosis,prevention and therapy of diabetic nephropathy.