血清糖化终末产物类物质与糖尿病慢性肾脏疾病的关系

The relationship between serum advanced glycation end products and chronic kidney disease in diabetes

目的探讨AGEs类物质在不同程度的糖尿病慢性肾脏疾病（CKD）患者体内的蓄积情况。方法选取糖尿病患者259例,根据24hUAlb分为单纯糖尿病（DM,UAlb300mg/24h）组53例、肾功能失代偿（CKD3,Scr 133-442μmol/L）组51例及尿毒症（U,Scr〉442μmol/L,持续血液透析治疗）组35例。另选同期体检健康者51名作为对照（NC）组。检测各组血清中AGEs、低分子量AGEs（LMWAGEs）和游离戊糖苷酶（FP）的荧光强度。结果 CKD1组血清AGEs荧光强度高于DM组和NC组,且DM组高于NC组[（14.94±3.07）vs（10.80±2.35）vs（6.23±1.25）U/mg],CKD3组高于CKD2组[（51.50±10.33）vs（15.57±3.20）U/mg]（P0.05）,其余各组两两比较差异均有统计学意义（P〈0.05）,且U组最高;U组血清FP荧光强度高于其他各组（P=0.001）,而其余各组两两比较,差异无统计学意义。结论测定血清AGEs和LMW-AGEs的水平可对早期肾损害的诊断、肾损害程度的分析及终末期肾病的评价提供帮助,FP主要适用于终末期肾病的评价,而对早期肾损害不敏感。

Objective To investigate the accumulation of advanced glycation end products（AGEs）in patients at different phases of chronic kidney disease（CKD）in diabetes. Methods A total of 259 cases of diabetes（DM）were divided into five groups according to the levels of 24halbuminuria（UAlb）：simple diabetes group（DM,n=58,UAlb30mg/24h）,microalbuminuria group（CKD1,n=62,UAlb 30-300 mg/24h）,clinical protein urine group（CKD2,n=53,UAlb〉300 mg/24h）,nitremia group（CKD3,n=51,Scr 133-442μmol/L）and uremia group（U,n=35,Scr〉442μmol/L,haemodialysis）.51 healthy volunteers served as normal controls（NC group）.The fluorescent intensity of AGEs,LMW-AGEs and free pentosidine（FP）in the serum were determined. Results Fluorescent intensity of AGEs in serum：CKD1group was higher than DM group and NC group and DM group was higher than NC group[（14.94±3.07）vs（10.80±2.35）vs（6.23±1.25）U/mg];CKD3group was higher than CKD2group[（51.50±10.33）vs（15.57±3.20）U/mg]（P〈0.05）.Fluorescent intensity of LMW-AGEs in serum：there was no statistically significant difference between group DM and group CKD1,CKD2 and CKD3（P〈0.05）;the remaining differences between two groups were statistically significant（P〈0.05）with U group was the highest.Fluorescent intensity of FP in serum：U group was higher than other groups（P=0.001）.The difference was not statistically significant in the rest of pairwise group comparison（P〈0.05）. Conclusion It would be valuable to measure the serum levels of AGEs and LMW-AGEs in screening of early nephropathy and evaluating the extent of renal damage.Monitoring the level of FP is sensitive to the evaluation of end-stage nephropathy but not in early-stage nephropathy.