2型糖尿病患者尿PCX、Nephrin及MCP-1水平在诊断早期肾病中的作用

The significance of detection of urinary podocalyxin, nephrin and monocyte chemoattractant protein-1 for diabetic nephropa-thy in newly diagnosed T2DM patients

目的通过对初诊2型糖尿病患者尿足细胞标志蛋白（PCX）、Nephrin及单核细胞趋化蛋白-1（MCP一1）进行检测，探讨三者对糖尿病肾病早期诊断的临床意义。方法2011年5月至12月本院内分泌科住院初诊2型糖尿病患者132例，分为糖尿病（DM）组[尿白蛋白／尿肌酐（UAlb／UCR）〈30mg／g]56例，糖尿病肾病（DN）组（UAIb／UCR≥30mg／g）76例；正常对照（健康体检者）36例。检测尿Podocalyxi（UPCX）、Nephrin（UNephfin）、MCP-1（UMCP-1）、白蛋白（UAlb）及尿肌酐（UCR）。比较各组UPCX／UCR、UNephrin／UCR、UMCP-1／UCR的差异及2型糖尿病患者上述各指标间的相关性及与UAlb／UCR的相关性，计算糖尿病患者UMCP．1／UCR、UNephrin／UCR、UPCX／UCR及三者联合检测的阳性率，并与UAlb／UCR的阳性率进行比较分析。结果DN组UAlb／UCR、UPCX／UCR和UMCP-1／UCR水平（90．394-59．35；72．11±58．88；104．82±82．77）比DM组（17．50±9．49；37．37±22．83；47．19．4-29。98）和健康对照组（8．934-3．81；9．594-2．28；9．98±3．63）明显升高（P〈0．05）；DM组UPCX／UCR、UMCP-1／UCR水平较正常对照组明显升高（P〈0．05）；UNephfiin/UCR水平在DN组（83．60±61．61）较DM组（38．74±35．27）明显升高（P〈0．05）。2型糖尿病患者UPCX／UCR、UMCP-1／UCR和UNephrin／UCR水平与UAlb／UCR呈正相关（r=0．619，0．568，0．535，P〈0．05）；UPCX／UCR水平与UMCP-1／UCR和UNephrin／UCR呈正相关（r=0．799，0．718，P〈0．05），UNephrin／UCR水平与UMCP-1／UCR水平呈正相关（r=0．635，P〈0．05）；UMCP-1／UCR，UNephrin／UCR与UPCX／UCR的阳性率较UAlb／UCR显著升高（x2=9．818，6．673，5．395，P〈0．05）。结论尿PCX、Nephrin和MCP-1单独或联合检测在早期糖尿病肾病诊断中具有重要的应用价值，较尿微量白蛋白更能反映早期糖尿病肾损害。

Objective To explore the significance of combined detection of urinary podocalyxin （ PCX）, nephrin and mono- cyte chemoattractant protein-1 （ MCP-1 ） for diabetic nephropathy in newly diagnosed type 2 diabetic patients. Methods A total of 132 newly diagnosed type 2 diabetes mellitus （T2DM） patients and 36 healthy subjects were recruited. The concentrations of urinary PCX （ UPCX）, nephrin （UNephrin） and MCP-1 （ UMCP-1 ） were measured with enzyme-linked immunosorbent assay （ ELISA）, and urina- ry UAE （UAlb） concentration was measured with turbidimetric immunoassay method. All the results were shown by dividing the urine creatinine （UCR） concentration in the same sample. The comparisons among UAlb/UCR, UPCX/UCR, UNephrin/UCR, and UMCP- I/UCR among groups were investigated. The correlation among UAlb/UCR, UPCX/UCR, UNephrin/UCR and UMCP-1/UCR was in- vestigated in rf2DM patients. The comparison among positive rate of UMCP-1/UCR, UNephrin/UCR, UPCX/UCR and UAlb/UCR was investigated in T2DM patients. Results The levels of UPCX/UCR and UMCP-1/UCR were significantly higher in diabetes melli- tus（DM） group （37. 37 ±22. 83 and 47. 19 ±29. 98, respectively） than in healthy subjects （9. 59 ±2. 28 and 9. 98 ±3.63, respec- tively） （ P 〈 0. 05 ）. The levels of UAlb/UCR, UPCX/UCR and UMCP-1/UCR were significantly higher in diabetic nephropathy （DN） group （90.39 ±59.35, 72. 11 ＋58.88, and 104.82 ±82.77, respectively） than in DM group （17.50 ±9.49, 37.37 ±22. 83, and 47. 19 ± 29.98, respectively） and in healthy subjects （8.93 ± 3.81, 9. 59 ±2. 28, and 9. 98 ± 3.63, respectively） （ P 〈0. 05）. The level of UNephrin/UCR was significantly higher in DN group （83.60 ±61.61 ） than in DM group （38. 74 ±35.27） （P 〈0. 05）. The levels of UPCX/UCR, UMCP-1/UCR, and UNephrin/UCR were positively correlated with UAlb/UCR （ r =0. 619, 0. 568, and 0. 535, respectively） （ P 〈 0. 05 ） in T2DM patients. The level of UPCX./UCR was positively correlated with the levels of UMCP-1/UCR and UNephrin/UCR （ r =0. 799 and 0. 718, respectively） （ P 〈0.05）. The level of UNephrin/UCR was positively correlated with the level of UMCP-1/UCR （ r =0. 635 P 〈0. 05） in T2DM patients. The positive rate of UMCP-1/UCR, UNephrin,/ UCR, and UPCX/UCR was significantly higher than that of UAlb/UCR（ X2 = 9. 818, 6. 673, and 5. 395, respectively, P 〈 0. 05 ）in T2DM patients. Conclusions The combined detection of urinary PCX, Nephrin and MCP-1 is very important for the early renal dam- age in newly diagnosed type 2 diabetic patients.