糖尿病肾病病程进展的临床和分子标志物

Clinical Indexes and Biomarkers of Diabetic Nephropathy Progression

糖尿病肾病(DN)自然病程差异悬殊,肾小球滤过率改变呈异质性,且肾小球病变、肾小管间质病变、肾血管病变与肾脏存活率密切相关,但白蛋白尿作为DN进展的观点受到挑战。临床上,除血清肌酐水平及肾小球滤过率外,还可以用尿足细胞排泄率,肾小球、肾小管和肾血管的组织病理改变反映DN病程的进展;同时,血液、尿液相关分子[血清肿瘤坏死因子受体(TNFR)1和TNFR2、尿液血管紧张素原等]也能在一定程度上反映DN病程的进展。学者们建议,将联合应用尿白蛋白排泄率+估算肾小球滤过虑(胱抑素C优于肌酐)+血清TNFR1或TNFR2作为DN进展的标志物。未来,基于尿液蛋白组学的研究会让人们对DN进展的认识进入新高度。

There are many differences in the natural progression of diabetic nephropathy（ DN）, the changes of glomerular filtration rate are heterogeneous. Glomerular lesions, tubulointerstitial lesions and renal vascular disease are closely associated with renal survival, but albuminuria as the progression marker of DN, is now challenged. Clinically,in addition to the level of serum creatinine and glomerular filtration rate, the urinary podocyte excretion rate, histopathologic changes of glomerulus and renal tubules and renal vessels can be used to reflect the progression of DN;at the same time, blood, urine related molecules[ serum tumor necrosis factor receptor （TNFR）1 and TNFR2,urine angiotensin original etc] can reflect the DN progression to a certain degree as well. The researchers suggest combining urinary albumin excretion rate, estimated glomerular filtration filter（cystatin C is better than serum creatinine）, and serum TNFR1 or TNFR2 to serve as markers of DN progression. The urinary proteomics-based studies may lead to a new level of understanding of DN progression.