糖尿病肾病的早期诊断

EARLY DIAGNOSIS OF DIABETIC NEPHROPATHY

目的 :探讨糖尿病肾病早期血浆Ⅳ型胶原 (Ⅳ -C)和尿液Ⅳ -C、视黄醇结合蛋白 (RBP)、转铁蛋白(TRF)、微量白蛋白 (mAlb)的变化及其临床意义。方法 :用ELISA法检测Ⅳ -C ,RBP及TRF ;免疫散射比浊法检测mAlb ;碱性苦味酸比色法测定尿肌酐。结果 :正常对照组中血浆Ⅳ -C ,尿Ⅳ -C ,尿RBP、尿TRF、尿mAlb的含量分别为 98± 2 2ng/ml,4.47± 1 .72ng/ml,1 7.1± 8.4ug/mmol.cr,80 .4± 2 0 .6ug/mmol.cr ,2 .0 2±0 .34mg/mmol.cr。在糖尿病无肾病组中 ,其mAlb的含量与正常对照组接近 (P >0 .0 5) ,但有 2 0 %的病人血浆Ⅳ -C ,尿液Ⅳ -C ,RBP和TRF的含量明显高于对照组 (P <0 .0 5)。在糖尿病早期肾病组和临床肾病组中血浆Ⅳ -C ,尿Ⅳ -C ,mAlb ,RBF和TRF的含量均明显高于正常对照组 (P <0 .0 1 )。结论 :联合检测血浆Ⅳ-C ,尿Ⅳ -C ,RBF和TRF对诊断早期糖尿病 ,及时对症治疗 ,防止终末期肾病有非常重要意义。

Objective:To determine the changes of plasma type IV collagen(IV-C),urinary IV-C,urinary retinol-binding protein(RBP),urinary transferrin (TRF) and urinary microalbumin (mAlb) in the early diabetic nephropathy, and their clinical significance.Methods:IV-C,RBP and TRF were determined by ELISA, mAlb by nephelometric immunoassay, and urinary creatinine by basic picric acid colorimetry.Results:In the normal control group,the levels of plasma IV-C,urinary IV-C,RBP,TRF and mAlb were 98±22ng/ml,4.47±1.72ng/ml, 17.1±8.4ug/mmol.cr, 80.4±20.6ug/mmol.cr and 2.02±0.34mg/mmol.cr, respectively.In the diabetic non-nephropathy group the level of mAlb was not obviously different form that of the control group ( P >0.05),but in 20% of the patients, the levels of plasma IV-C, urinary IV-C,RBP and TRF were significantly higher than those of the control group ( P <0.05).In the early diabetic nephropathy and the clinical diabetic nephropathy groups,the levels of plasma IV-C,urinary IV-C, mAlb,RBP and TRF were all much higher than those of the control group ( P <0.01).Conclusions:Combined determination of plasma IV-C,urinary IV-C, RBP and TRF is of very important significance in diagnosis and treatment of early diabetic nephropathy and in prevention of therminal diabetic nephropathy.