尿液锌α2糖蛋白水平与糖尿病肾病肾小管损伤的相关性

Study on the Correlation of the Urinary ZAG Level and Renal Tubular Injury in Diabetes Nephropathy

目的探讨糖尿病肾病(diabetes kidney disease,DKD)患者尿液锌α2糖蛋白(zinc-α2-glycoprotein,ZAG)水平的变化及其临床意义。方法选取2016年1月至2018年1月新疆医科大学第四附属医院肾病科与新疆医科大学第五附属医院肾病科收治的DKD患者84例为研究对象,根据肾小管间质损伤程度分为轻度病变组32例、中度病变组27例、重度病变组25例,并选取78例糖尿病未累及肾脏病变患者作为对照组,检测各组患者尿液ZAG的表达水平,并分析探讨其与临床病理资料的相关性,通过Logistic回归分析探讨ZAG预测DKD患者肾功能进展的临床价值。结果对不同肾脏病变程度组及对照组的各项临床资料进行比较,估算肾小球滤过率(estimated glomerular filtration rate,eGFR)和血清白蛋白水平在重度病变组<中度病变组<轻度病变组<对照组,尿ZAG、血肌酐水平和尿蛋白肌酐比在重度病变组>中度病变组>轻度病变组>对照组,差异均有统计学意义(P均<0.05)。DKD患者尿液ZAG表达水平与血肌酐和尿蛋白肌酐比呈正相关,与eGFR和血清白蛋白呈负相关(P均<0.05)。高龄、高水平的基线血肌酐、尿蛋白肌酐比和尿ZAG及低水平的基线eGFR是DKD患者肾功能进展的独立危险因素(P均<0.05)。结论DKD患者尿液ZAG的表达水平升高,肾小管间质和血管病变程度越重的患者表达水平越高。尿液ZAG表达水平较高的DKD患者肾功能进展较快,预后不良。

Objective To investigate the levels of urine zinc-α2-glycoprotein(ZAG)in diabetes kidney disease and its clinical significance.Methods From January 2016 to January 2018,84 patients with diabetes kidney disease admitted to Department of Nephrology,the Fourth Affiliated Hospital of Xinjiang Medical University and Department of Nephrology,the Fifth Affiliated Hospital of Xinjiang Medical University were selected as the study objects.According to the degree of renal tubulointerstitial damage,they were divided into mild lesions group(32 cases),moderate lesions group(27 cases)and severe lesions group(25 cases).78 cases of diabetic patients without renal lesions were selected as the control group,and urine ZAG level in each group was detected.The correlation between ZAG and clinical pathological was analyzed.The clinical value of ZAG in the prognosis of renal function in diabetes kidney disease was explored through Logistic regression analysis.Results Compared with the clinical data of different pathological degrees of renal interstitial diseases and the control group,the eGFR and serum albumin levels in the severe pathological changes group<moderate pathological changes group<mild pathological changes group<control group,the levels of urinary ZAG,serum creatinine and urinary protein creatinine ratio in the severe pathological changes group>moderate pathological changes group>mild pathological changes group>control group,they were statistically significant(P all<0.05).The level of urinary ZAG in diabetes kidney disease was positively correlated with serum creatinine and urinary protein to creatinine ratio,and negatively correlated with eGFR and serum albumin(P all<0.05).Older age,higher level of baseline serum creatinine,urinary protein to creatinine ratio,urinary ZAG,and lower level of baseline eGFR were independent risk factors for the progression of renal function in diabetes kidney disease(P all<0.05).Conclusion The levels of urinary ZAG in diabetes kidney disease is increased,and closely associated with the renal tubulointerstitial and vascular lesions.Diabetes kidney disease patients with high level of urinary ZAG experienced with a rapid progressive renal function and a poor renal prognosis.