肾小球高滤过对儿童1型糖尿病早期肾脏损害评估的临床意义

Clinical significance of glomerular hyperfiltration in assessment of early renal damage in childhood type 1 diabetes

目的研究肾小球高滤过(GHF)对于早期1型糖尿病肾脏病的筛查价值。方法入选100例1型糖尿病患儿,用Macisaac’s公式估算其肾小球滤过率(e GFR),并按照e GFR水平将患儿分为高滤过组43例,正常滤过率组57例,比较两组患儿的临床资料。结果高滤过组糖化血红蛋白(Hb A1c)及三酰甘油(TG)水平高于正常滤过率组,而血中性粒细胞明胶酶相关载脂蛋白(NAGL)水平低于正常滤过率组,差异均有统计学意义(P<0.05);高滤过组和正常滤过率组的尿微量白蛋白/肌酐比值(UACR)、尿N-乙酰-β-D-氨基葡萄糖苷酶/肌酐比值(NAG/Cr)、尿α1微球蛋白/肌酐比值(α1-MG/Cr)的差异则均无统计学意义(P>0.05)。Logistic回归分析显示,病程短、Hb A1c高为GHF的危险因素。结论 GHF可反映1型糖尿病患儿血糖、血脂的紊乱情况,其与糖尿病患儿肾脏损伤的相关性需进一步研究。

Objective To investigate the screening value of glomerular hyperfiltration（GHF） in early renal damage of type 1 diabetes. Methods The estimated glomerular filtration（e GFR） was calculated using the Macisaac＇s equation in 100 cases of type 1 diabetes. According to e GFR＇s level, the diabetes were divide into two groups： Normo-GFR group, 57 cases; and GHF group, 43 cases. The age, course of disease, glycosylated hemoglobin（Hb A1 c）、triglyceride（TG）, renal glomerular damage indexes（UACR）, and renal tubular damage indexes（urinary NAG/Cr, urinary α1-MG/Cr and serum NGAL） of each group were observed. Results The Hb A1 c and TG values in the GHF group was significantly higher than those in the Normo-GFR group（P0.05）. Serum NGAL values in the GHF group was significantly lower than those in the Normo-GFR group（P0.05）. The UACR, urine NAG/Cr and urine α1-MG/Cr values between the GHF group and Normo-GFR group were not significantly different. Logistic regression analysis showed shorter diabetes duration and higher Hb A1 c levels were important influence factors of whether diabetes patients had hyperfiltration. Conclusions GHF may reflect abnormal glucose and lipid metabolism that could be detected at early stage of the type 1 diabetes, but its independent correlation with diabetic kidney damage needs further research.