血、尿NGAL在2型糖尿病肾病进展各阶段的变化及其临床意义

Changes of blood and urine NGAL level during each stage of type 2 diabetic nephropathy progression and its clinical significance

目的:探讨血、尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在2型糖尿病肾病(T2DN)进展各阶段中的变化及临床意义。方法:选择2015年5月~2018年1月入院治疗的T2DN患者240例(T2DN组)。根据24h尿微量白蛋白排泄率(UAER)水平,患者被分为尿蛋白正常(NAU)组(88例,<20mg/24h)、微量蛋白尿(MAU)组(80例,30~300mg/24h)和大量蛋白尿(MPU)组(72例,>300mg/24h)。选择同期入院健康体检者100例,设为健康对照组。测量比较各组血、尿NGAL、血清尿素氮(BUN)、血肌酐(Scr)和胱抑素C(CysC)水平,分析血、尿NGAL水平与上述指标的相关性。结果:与健康对照组比较,T2DN组血NGAL[(0.03±0.00)μg/L比(22.32±3.21)μg/L]、尿NGAL[(1.53±0.08)μg/L比(7.35±2.39)μg/L]、血清BUN[(8.32±1.84)mmol/L比(16.46±2.15)mmol/L]、Scr[(138.46±34.09)μmol/L比(290.48±43.41)μmol/L]和CysC[(1.52±0.46)mg/L比(3.97±1.23)mg/L]水平均显著升高,P均=0.001。上述指标水平均符合:NAU组<MAU组<MPU组,两两比较均有显著差异,P<0.05或<0.01。Pearson相关分析显示血、尿NGAL水平与血清BUN、Scr和CysC水平均呈显著正相关(r=0.189~0.663,P均<0.01)。结论:2型糖尿病肾病不同阶段常伴有血、尿NGAL水平升高,加强NGAL水平监测有助于评估患者肾脏功能,为临床诊疗提供依据,值得推广应用。

Objective:To explore changes of blood and urine levels of neutrophil gelatinase associated lipocalin(NGAL)during each stage of type 2 diabetic nephropathy(T2DN)progression and its clinical significance.Methods:A total of 240 T2DN patients treated in our hospital from May 2015 to Jan 2018 were selected.According to 24h urinary albumin excretion rate(UAER)level,patients were divided into normoalbuminuria(NAU)group(n=88,<20mg/24h),microalbuminuria(MAU)group(n=80,30~300mg/24h)and massive proteinuria(MPU)group(n=72,>300mg/24h).Another 100 healthy subjects undergoing physical examination simultaneously were regarded as healthy control group.Levels of blood and urine NGAL,serum blood urea nitrogen(BUN),serum creatinine(Scr)and cystatin C(CysC)were measured and compared among above groups,and the correlation among blood,urine NGAL levels and above blood biomarkers was analyzed.Results:Compared with healthy control group,there were significant rise in levels of blood NGAL[(0.03±0.00)μg/Lvs.(22.32±3.21)μg/L],urine NGAL[(1.53±0.08)μg/L vs.(7.35±2.39)μg/L],serum BUN[(8.32±1.84)mmol/L vs.(16.46±2.15)mmol/L],Scr[(138.46±34.09)μmol/L vs.(290.48±43.41)μmol/L]and CysC[(1.52±0.46)mg/L vs.(3.97±1.23)mg/L]in T2DN group,P=0.001 all.Levels of all above indexes were accorded with NAU group<MAU group<MPU group,there existed significant difference between any two groups,P<0.05 or<0.01.Pearson correlation analysis indicated that blood and urine NGAL levels were significant positively correlated with serum levels of BUN,Scr and CysC(r=0.189~0.663,P<0.01 all).Conclusion:Different stage of type 2 diabetic nephropathy is often complicated with elevated blood and urine NGAL levels.Enhancing NGAL level monitor is help for assess renal function and provide reference for clinical diagnosis and treatment,which is worth extending.