糖尿病早期肾病监控指标的探讨

Urinary Markers of Detecting Early Renal Injury in Patient with Diabetes Mellitus(DM)

目的探讨非胰岛素依赖型糖尿病 (NIDDM)早期肾脏损伤的诊断方法。方法采用速率散射比浊法检测尿微量白蛋白 (m AL B)、全定量酶免疫法测定尿视黄醇结合蛋白 (RBP) ;速率法检测 N-乙酰 -β- D-氨基葡萄糖苷酶(NAG) ;Jaffe速率法测定尿肌酐。结果对照组尿 m AL B/Cr为 (1.5 4± 0 .76 ) m g/mm ol,RBP/Cr为 (2 7.5± 19.1)μg/m mol,NAG/Cr为 (1.6 6± 1.0 5 ) U /mm ol。微量白蛋白尿组与大量白蛋白尿组 RBP/Cr、NAG/Cr较对照组及正常白蛋白尿组显著增高 (P<0 .0 1)。单项及二项检测 m AL B、RBP、NAG这三项指标阳性率较低 ,联合三项指标检测阳性率可达 83.1%。正常白蛋白尿、微量白蛋白尿及大量白蛋白尿患者 ,m AL B、RBP和 NAG三项指标间均呈显著正相关。结论联合检测尿 m AL B、RBP和 NAG是诊断 NIDDM患者肾脏早期损伤灵敏、可靠的实验室指标。

Objective To investigate detection basis of early renal injury in non-insulin dependent diabetes mellitus(NIDDM) patients.Methods Rate nephelometry was employed to measure urinary microalbumin levels,and total quantitive enzyme immunoassay for urinary retinol binding protein(RBP) levels.Urinary N-acetyl-beta-D-glucosaminidase(NAG) was determined with reaction rate assay,and urinary creatinine(Cr) with Jaffe's rate.Results The ratios of urinary mALB/Cr,RBP/Cr,NAG/Cr in the control were 1.54±0.76 mg/ml,2.75±19.1 μg/mmol,1.66±1.05 U/mmol,respectively.The ratios of RBP/Cr and NAG/Cr in patients with microalbuminuria and macroalbuminuria were significantly higher than those in controls and patients with normalbuminuria( P <0 01).Measuring three markers together would raise the positive rate to 83.1% in DM. A significant positive correlation between mALB,RBP and NAG was found.Conclusion The method is sensitive and reliable to measure mALB,RBP and NAG toge- ther for diagnose of early renal injury in NIDDM.\;