2型糖尿病患者尿液mindin水平与糖尿病肾病的相关性

Correlation between diabetic nephropathy and the level of urinary mindin in patients with type 2 diabetes mellitus

目的探讨2型糖尿病（T2DM）患者尿液mindin的表达，分析其与糖尿病肾损伤的关系。方法选取2010年10月至2011年6月于广西医科大学第一附属医院代谢糖尿病中心及内分泌科住院的T2DM患者124例为病例组，选取同期年龄、性别匹配的健康体检者30名作为对照组。根据24h尿白蛋白定量（24h-UAE）将T2DM患者分为3组，即24h—UAE〈30mg的正常蛋白尿组60例，30mg≤24h-UAE〈300mg的微量蛋白尿组32例，24h-UAE≥300mg的大量蛋白尿组32例。应用ELISA法测定尿液mindin的水平，常规方法测定血、尿肌酐、血尿素氮、胱抑素C、空腹及餐后血糖、糖化血红蛋白（HbA1c）、C-肽等临床指标，并估算肾小球滤过率（eGFR）。组间比较采用单因素方差分析及q检验，指标间的相关分析采用Spearman相关分析及偏相关分析。结果T2DM患者尿mindin含量高于对照组f正常蛋白尿组、微量蛋白尿组、大量蛋白尿组、对照组分别为161（119～255）、332（181—445）、426（230—937）和93（51—121）ng·ml^-1·μmol^-1·L^-1，F=30．196，P〈0．05]，并与24h-UAE呈正相关（r=0．453，P〈0．05），T2DM患者各组mindin水平随24h-UAE的升高而递增；相关分析显示尿mindin与尿素氮、血肌酐、胱抑素C、血糖、24h-UAE、病程呈正相关（r=0．426、0．2336、0．383,0344、0．453、0．511，均P〈0．05），而与eGFR呈负相关（r=-0．383，P〈0．05）；结果显示尿液mindin（OR=1．481，95％CI：1.187—1．847）、空腹血糖（OR=0．842，95％CI：0．756～0．939）、舒张压（OR=1．051，95％CI：1．003～1．101）是T2DM患者肾损伤的危险因素。结论尿液mindin可反映糖尿病肾病早期肾功能损伤并与肾功能损伤的程度相关，尿液mindin的检测对糖尿病肾病患者早期诊断、病情观察、疗效判断方面具有较好的临床应用前景。

Objective To evaluate the level of urinary mindin in patients with type 2 diabetes mellitus （T2DM） , and analyze the association between the renal injury and the lvels of urinary mindin. Methods Type 2 diabetic patients （ n = 124 ） with normoalbuminuria （ urinary albumin 〈 30 rag/24 h, n = 60） ,microalbuminuria （30 ≤ urinary albumin 〈 300 mg/24 h, n = 32 ） , macroalbuminuria （ urinary albumin ≥ 300 rag/24 h, n = 32 ） , and normal control group （n = 30 ） were enrolled. The levels of urinary mindin were measured by using ELISA kits, the serum/urine creatinine, serum urea nitrogen, eystatin C, blood glucose, glycated hemoglobin, C-peptide and other clinical indicators were measured by conventional methods. The estimated eGFR level was calculated using the formula proposed by Macisaac, and statistical analysis were made with the SPSS 13.0 software. Results The levels of urinary mindin in the T2DM group were significantly higher than those of the normal control group which were increased gradually with the increases of albuminuric levels. The urinary mindiu levels in patients with normoalbuminuria, microalbuminuria, macroalbuminuria and normal controls were 161 （ 119 - 255 ） , 332 （ 181 - 445 ） , 426（230 -937） and 93 （51 ± 121）ng·ml^-1·μmol^-1·L^-1,respectively（F=30.196,P〈0.05）. Urinary ufindin was correlated with urinary albumin（ r = 0. 453 ,P 〈 0. 05 ） ; The level of urinary mindin was positively correlated with serum urea nitrogen （ r = 0. 426, P 〈 0. 05 ）, ereatinine （ r = 0. 236, P 〈 0. 05 ）,cystatin C （ r = 0. 383, P 〈 0.05 ）, blood glucose （ r = 0. 344, P 〈 0.05 ）, 24 h-urinary albumin （ r = 0. 453, P 〈 0. 05 ） and the course of diabetic disease （ r = 0. 511, P 〈 0. 05 ） , which was negatively correlated with eGFR（r = -0. 383 ,P 〈0. 05） ;Logistic regression analysis showed that the urinary mindin might be one of the high-risk factors to identify renal injury in patients with T2DM. Conclusion This study indicates that urinary mindin might be closely related to diabetic nephropathy and in participates in the progress of diabetic nephropathy; urinary mindin can reflect the early course of renal injury and be associated with renal function. Urinary mindin needs to be investigated as a potential marker for diabetic nephropathy early diagnosis and indicator of curative effect.