血清糖化清蛋白在早期诊断糖尿病肾病中的应用价值

The value of serum glycated albumin in early diagnosis of diabetic nephropathy

目的 分析血清糖化清蛋白（GA）在早期诊断糖尿病肾病中的应用价值,为临床检测和诊断疾病提供新的方法.方法 连续收集本院2013年3月至2014年3月诊断为2型糖尿病患者共65例,所有患者门诊及住院定期监测空腹血糖、HbA1c、24 h尿蛋白定量和GA水平,均根据糖尿病治疗指南给予合理的降糖药物或胰岛素治疗,预防并发症.随访约1年后的糖尿病肾病的发病率（糖尿病肾病均经肾穿刺活检＋病理诊断确诊）,对比分析糖尿病肾病组及非糖尿病肾病组患者的危险因素.结果 65例患者随访平均（19.8±4.6）月,共诊断糖尿病肾病23例,发病率为35.38%.两组患者的空腹血糖、HbA1c和24 h尿蛋白定量的比较,差异均无统计学意义（P〉0.05）;而糖尿病肾病组的GA水平显著高于非糖尿病肾病组,差异有统计学意义（P〈0.05）.纳入多因素Logistic回归分析可知,糖尿病病史、血糖水平、GA水平和24 h尿蛋白定量均是影响糖尿病肾病的独立危险因素,且GA水平的危险度较高（OR=1.527）.糖尿病肾病组内不同分期的比较,差异有统计学意义（P〈0.001）,GA水平随着病情加重而逐渐升高.GA水平与HbA1c间的Pearson检验,可知无相关性（r=0.123,P=0.527）.结论 血清糖化清蛋白可作为短期和较早诊断糖尿病肾病的重要指标.

Objective To study the value of serum glycated albumin（GA） in early diagnosis of diabetic nephropathy（DN）.Methods A total of 65 consecutives diagnosed as type 2 diabetes mellitus from March 2013 to March 2014 were given exams of fasting blood glucose（FBG）,glycosylated hemoglobin（HbA1c）,24 h urinary protein and GA levels,they were received standard treatments according to the guideline,then to analyze DN rate（diagnosed by renal biopsy＋pathology） of one-year follow-up,and compare the risk factors to DN.Results There were up to 23 cases of DN（35.38%） in the follow-up of mean（19.8±4.6）months.the FBG,HbA1c and 24 h urinary protein levels in the two groups were no statistical differences（P〉0.05）;however,the GA level in DN group was significantly higher（P〈0.05）.the diabete history,FBG level,GA level and 24 h urinary protein level were all the independent risk factors to DN by the Logistic regression analysis,and the OR value of GA level was 1.527.What′more,the GA level was higher as stages of DN aggravating（P〈0.001）.there was no correlation between GA level and HbA1c value by Pearson test（r=0.123,P=0.527）.Conclusion Serum GA may be an early and short period indicator to DN.