糖尿病肾病患者血清NGAL和APN的改变及其临床意义

目的：探讨糖尿病肾病（DN）患者血清中性粒细胞明胶酶相关载脂蛋白（NGAL）、脂联素（APN）的改变及其临床意义。方法选择2型糖尿病（T2DM）患者71例，根据尿微量白蛋白/肌酐比值（ACR）分为3组，正常白蛋白尿（NA）组27例、微量白蛋白尿（MA）组23例、临床白蛋白尿（CA）组21例，同期选取非肾病患者25例作为对照组。应用ELISA法检测患者血清NGAL（sNGAL）水平和血清APN（sAPN）水平，分析血清NGAL及APN水平与尿微量白蛋白/肌酐比值（ACR）和肾小球滤过率（GFR）之间的相关关系。结果（1）随着ACR水平的升高，肾功能下降，血清NGAL、APN水平逐渐升高。NA组、MA组和CA组的血清NGAL均较对照组升高，差异均有统计学意义（P均〈0.05）。MA组较NA组的血清NGAL水平升高，但差异无统计学意义（P〉0.05）。NC组、NA组、MA组、CA组、各组间血清APN水平逐渐升高，差异均有统计学意义（P均〈0.05）。（2）糖尿病患者血清NGAL与ACR呈正相关性（r=0.854，P〈0.01），血清APN与ACR亦呈正相关性（r=0.828， P〈0.01）。血清NGAL与GFR呈负相关性（r=-0.751，P〈0.01），血清APN与GFR亦呈负相关性（r=-0.816，P〈0.01）。结论糖尿病患者血清NGAL和血清APN可能参与了DN的发生与发展，有望成为DN肾损害的预测指标，用于临床监测。

Objective To explore the changes of serum NGAL and APN in patients with diabetic nephropathy and their clinical significance. Methods seventy-one type 2 diabetic patients were divided,according to albuminuria to creatinine ratio（ACR）into groups of NA（normal albuminuria n=27）,MA（micro albuminuria n=23）,CA（clinical albuminuria n=21）,and another 25 patients without nephropathy were chosen as control group.NGAL and APN levels were detected by ELISA.The relationship of NGAL and APN with albuminuria to creatinine ratio（ACR）and glomerular filtration rate（GFR）were analyzed. Results NGAL and APN levels increased with the increase of ACR and renal function decline in each group.The NGAL levels of NA/MA/CA groups were significantly higher than the normal control groups（all P〈0.05）.The NGAL level of the MA group was not significantly higher than the NA group （P〉0.05）.The serum APN levels increased with the increase of ACR in each group（all P〈0.05）. The serum NGAL and APN levels in patients with diabetic nephropathy were positively correlated with ACR（r=0.854,0.828,P〈0.01）,and were negatively correlated with GFR（r=-0.751,-0.816,P〈0.01）. Conclusion NGAL and APN may play an important role in the occurrence and development of DN. Serum NGAL and APN might be predictors of the severity of DN and is expected to be used in clinical monitoring.