尿中性粒细胞明胶酶相关脂质运载蛋白和肾损伤因子-1在糖尿病肾病早期诊断中作用的研究

Value of urinary NGAl and KIM-1 in diagnosing early phase of diabetic nephropathy

目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和肾损伤因子-1(KIM-1)水平在DN早期诊断中的意义。方法 48例T2DM患者根据UAER分为正常白蛋白尿(NA)组,微量蛋白尿(MA)组和临床肾病(CA)组,同时随机选取同期健康体检者12名为健康对照(NC)组。检测尿NGAL和KIM-1水平,分析两者与肾小球率过滤(GFR)的关系。应用受试者工作特征曲线(ROC)观察DN患者的敏感性和特异性。结果各组NGAL水平随UAER水平增加而增加,且组间差异有统计学意义(P<0.05);各组KIM-1水平与NC组相比均显著提高(P<0.05),且CA组与其他组比较,差异有统计学意义(P<0.05);DN患者NGAL和KIM-1与GFR呈负相关(r分别为-0.844和-0.747,P<0.01),且尿NGAL和GFR的关系更密切;DN患者NGAL和KIM-1的ROC曲线下面积分别为0.875和0.790。结论尿NGAL水平有望作为一种敏感指标用于临床监测,以期比UAlb测定更早诊断T2DM患者的肾脏损害。

Objective To explore the clinical changes and diagnostic significance of urine neutrophil gelatinase-associated lipocalin（NGAL） and kidney injury molecule-1（KIM-1） in diabetic nephropathy（DN）.Methods Forty-eight type 2 diabetic patients were divided,according to urinary albumin excretion rate（UAER）,into groups of normal albuminuria（NA）,micro albuminuria（MA）,clinical albuminuria（CA）,and another 12 healthy subjects were randomly chosen as control group.NGAL and KIM-1 levels were detected by ELISA.The relationship of NGAL and KIM-1 with glomerular filtration rate（GFR） was analyzed and the sensitivities of NGAL and KIM-1 were evaluated by receiver operating characteristic（ROC） curve in diagnosis of DN.Results NGAL levels increased with the increase of UAER in each group（all P0.05）.Compared to control group,KIM-1 levels in diabetic groups elevated significantly（P0.05）.Significant difference in KIM level was demonstrated between CA group and the other two groups（NA and MA）（P0.05）.Pearson correlation analysis showed that urinay NGAL and KIM-1 levels were negatively correlated with GFR（r=-0.844,-0.747;P0.01）,and the areas under ROC curve were 0.875 and 0.790,respectively.Conclusion Urinary NGAL level might be a sensitive indicator for clinical monitoring,so as for early diagnosis of type 2 DN.