中性粒细胞明胶酶相关脂蛋白和胱抑素C作为糖尿病肾病早期标志物的评价

Evaluation of neutrophil gelatinase-associated lipoprotein and cystatin C as early markers for the diagnosis of diabetic nephropathy

目的探讨糖尿病肾病患者血清和尿液中性粒细胞明胶酶相关脂质体(NGAL)和胱抑素C(Cys-C)水平在检测早期肾损伤中的临床价值。方法将160例2型糖尿病患者根据尿白蛋白/肌酐比值(UACR)分为两组:正常蛋白尿(UACR<30 mg/g)为对照组;微量白蛋白尿(UACR≥30 mg/g)为疾病组。对两组患者进行血清NGAL(S-NGAL)、尿液NGAL(U-NGAL)和血清Cys-C(S-Cys-C)测定,并研究其与尿微量白蛋白的相关性。结果与对照组相比,疾病组患者U-NGAL、S-NGAL、S-Cys-C水平显著升高(P<0.05)。尿白蛋白与S-NGAL和U-NGAL呈正相关(P<0.05)。U-NGAL与糖尿病病程、血脂异常呈正相关(P<0.05)。受试者工作特征(ROC)曲线分析表明,U-NGAL和S-NGAL诊断糖尿病肾病曲线下面积分别为0.928和0.826,诊断敏感度分别为81.9%和75.2%,特异度分别为93.2%和84.6%。结论在尿微量白蛋白阴性2型糖尿病患者中,尿生物标志物与非糖尿病对照组相比显著升高,在微量白蛋白尿发展之前,可作为早期肾损伤的标志物。

Objective To investigate the clinical value of serum and urine levels of neutrophil gelatinase-associated liposome(NGAL) and cystatin C(Cys-C) in detecting early renal injury in patients with diabetic nephropathy.Methods The serum and urine levels of NGALs and Cys-C were measured in 160 patients with type 2 diabetes mellitus(T2 DM), and the correlation between NGALs and microalbuminuria was studied. Results Compared with albuminuria negative control group, U-NGAL and S-NGAL levels in patients with microalbuminuria were significantly increased. S-Cys-C in patients with microalbuminuria was also higher than that in patients with normal albuminuria. Urinary albumin excretion was positively correlated with S-NGAL and U-NGAL. U-NGAL was positively correlated with the duration of diabetes, glycosylated hemoglobin(HbA1 C), and dyslipidemia. ROC analysis showed that the areas under U-NGAL and S-NGAL curves were 0.928 and 0.826, respectively, indicating that they were sensitive markers of early renal damage.Conclusion Urinary biomarkers in patients with albuminuria negative T2 DM are significantly higher than those in non-diabetic controls. Urinary biomarkers could be used as biomarkers of early renal disease before the development of early urinary microalbuminuria.