尿血管紧张素原在不伴高血压的糖尿病患者肾损害中的意义

The significance of urinary angiotensinogen for renal injury in diabetic patients without hypertension

目的探讨尿血管紧张素原(urinary angiotensinogen,UAGT)在不伴高血压的糖尿病患者肾损害中的意义。方法单中心横断面研究,102例不伴高血压、未服用RAS阻断剂的糖尿病患者,根据尿白蛋白/肌酐(UALB/Cr)分为尿蛋白阴性组、微量蛋白尿组和大量蛋白尿组,18例健康人作为对照组,收集人口学资料、生化指标,ELISA法检测UAGT。结果与健康对照组相比,尿蛋白阴性组患者尿血管紧张素原/肌酐(UAGT/Cr)即显著升高(P<0.001),伴随舒张压显著升高和eGFR显著降低(P<0.01),大量蛋白尿组患者这种差异进一步明显,相关分析显示UAGT/Cr与舒张压、UALB/Cr独立相关(P<0.01),回归分析显示糖尿病患者UAGT是eGFR降低独立的危险因素。结论本研究发现尿AGT在不伴高血压且尿蛋白阴性的糖尿病患者即开始升高,在糖尿病肾病患者进一步升高,且可能与肾损害进展相关。尿AGT有可能成为预测糖尿病患者肾损害的早期指标。

Objective To demonstrate the value of urinary angiotensinogen （UAGT） for renal func- tion in diabetic patients without hypertension. Methods This was a single center and cross-section study. A total of 102 diabetic patients without ACEI or ARB treatment and hospitalized in Peking University third Hospital fxom September 2012 to December 2012 were enrolled in this study. Based on the value of urinary albumin/creatinine （UALB/Cr）, patients were divided into 3 groups： negative albuminuria group, trace albu- minutia group, and severe albuminuria group. Eighteen healthy individuals were also included as the control group. Their gender, age, blood pressure, renal function and urinary protein were collected. UAGT was mea- sured by ELISA. Results As compared with control group, the increase of UAGT/creatinine ratio （UAGT/Cr） （P 〈 0.001） accompanied by the increase of diastolic blood pressure and the decrease of eGFR （P 〈 0.01） were found in negative albuminuria group. This tendency became predominant in severe albuminuria group. Correlation analysis indicated that UAGT/Cr was correlated independently with diastolic blood pressure and UALB/Cr （P 〈 0.01）. Regression analysis demonstrated that UAGT was the independent risk factor for the decrease of eGFR in diabetic patients. Conclusion Our results indicate that the increase of UAGT begins earlier in the diabetic patients without hypertension and albuminuria, and advances further in patients with diabetic nephropathy. The increase of UAGT may relate to the deterioration of renal function in diabetic nephropathy patients. UAGT may be a useful marker for the early prediction of renal damage in diabetic patients.