尿α1-酸性糖蛋白在早期糖尿病肾病诊断中的应用价值

Value of Urinary α1-Acid Glycoprotein in Early Diagnosis of Diabetic Nephropathy

目的探讨尿α1-酸性糖蛋白（AAG）在早期糖尿病肾病（DN）诊断中的应用价值。方法选取2013年5月～2014年10月南京大学医学院附属鼓楼医院诊治的2型糖尿病（T2DM）患者266例，根据尿微量清蛋白／肌酐（ACR）水平，将患者分为单纯糖尿病组（Non-DN）152例和糖尿病肾病组（DN）114例，其中DN组包括低尿微量清蛋白／肌酐组（LUA）49例，高尿微量清蛋白／肌酐组（HUA）32例和极高尿微量清蛋白／肌酐组（VHUA）33例。选取健康体检者63例为正常对照组（NC），骨折患者66例为应激对照组。测定尿AAG及各项生化指标。结果DN组尿AAG水平明显高于应激对照组、Non-DN组和NC组，差异具有统计学意义（t=7．951，7．985和8．021，P均〈0．05）；随DN病程进展，尿AAG水平从LUA组、HUA组到VHUA组呈依次递增趋势，各组间差异具有统计学意义（P〈0．05）。尿AAG与血尿酸、血肌酐、C-反应蛋白和ACR均呈正相关（r=0．169，0．286，0．373和0．606，P均〈0．01）。逐步Logistic回归分析表明尿AAG是DN的独立危险因素（P〈0．05）。结论尿AAG在早期DN诊断和监测病程进展等方面具有良好的应用前景。

Objective To investigate the clinical value of urinary al-acid glycoprotein （AAG） in the early diagnosis of diabetic nephropathy（DN）. Methods 266 cases of diabetic patients in Drum Tower Hospital Affiliated to Medical School of Nanjing University from May 2013 to October 2014 were recruited,and patients were divided into four groups based on the urine α1- bumin/creatinine （ACR） levels, as follows ： non-diabetic nephropathy group （Non-DN） 152 cases, low urinary albumin/creatinine group （LUA） 49 cases,high urinary albumin/creatinine group （HUA） 32 cases,and very high urinary albumin/creatinine group （VHUA） 33 cases. 63 cases of healthy subjects （NC group） and 66 cases of fracture patients （stress group） were recruited as control group. The urinary AAG and other biochemical indicators were measured for all subjects. Results The level of urinary AAG in DN group was significantly higher than that in stress group, Non-DN group and NC group （t= 7. 951,7. 985,8.02] ,P〈0. 05） ,and gradually increased from LUA, HUA to VHUA group （P〈0.05）. The urinary AAG level was positively correlated with UA,Cr,CRP and ACR （r=0. 169,0. 286,0. 373,0. 606,P〈0.01）. Stepwise logistic regression analysis showed that the urinary AAG was the independent risk factor of DN （P（0.05）. Conclusion The level of urinary AAG has good application value in the early diagnosis and monitoring progression of DN.