1型糖尿病患者尿微量球蛋白IgM的检测及价值

Study on the testing and the diagnostic value of the urine IgM excretion in urine in patients with type 1 diabetes mellitus

目的探讨1型糖尿病(T1DM)患者尿中微量免疫球蛋白M(Ig M)水平的变化及意义。方法随访观察常规诊疗的89例T1DM患者,定期测定尿液微量球蛋白Ig M的含量,统计分析其Ig M的水平与心血管事件死亡率和进展为终末期肾病(ESRD)的关系。结果观察病例中,有8例死于心血管事件,6例ESRD,其Ig M含量均明显高于无心血管事件和保存部分肾功能的1型糖尿病患者(P<0.01)。尿微量球蛋白蛋白含量增加,心血管事件死亡率和发展到ESRD的相对危险度(RR)分别是4.9和7.8。结论 1型糖尿病患者尿中Ig M的排泄增加和心血管事件病死率或ESRD密切相关,高含量的尿Ig M预示患者心血管死亡和发展到ESRD的风险增大,早期测定尿Ig M,筛查并进行针对性的治疗对1型糖尿病心血管事件的防治和提高患者的生活质量及预后有积极意义。

Objective To assess the testing and value of the urine Ig M excretion in urine predicting cardiovascular（CV）mortality in the patients with the type 1 diabetes mellitus. Methods Urine Ig M concentration was measured at time of recruitment and during the course of the study. The relationship was assessed between the Ig M levels in urine and the CV mortality and end-stage renal disease（ESRD）. Results 8 patients died in cardiovascular event and 6 patients reached ESRD. Compared to participants with urine Ig M, those with higher urine levels had a higher risk of CV death and ESRD ： the RR were 4.9（95%CI ： 3.3~14.0） and 7.8（95%CI ： 3.5~18.1）（P〈0.01 for linear trend）. Conclusion An increase of the Ig M excretion in urine is associated with an increase of the risk for CV mortality and renal failure. The patients with higher Ig M excretion in urine will be more dangerous. The higher level of Ig M in urine indicates that the higher risk of CV mortality and ESRD.