1型糖尿病患儿肾小管功能损伤影响因素分析

Risk factors for renal tubular dysfunction in children with type 1 diabetes mellitus

目的调查1型糖尿病(T1DM)患儿尿液中肾小管损伤标志物水平,分析肾小管功能损伤的影响因素。方法收集95例T1DM患儿和50例正常对照儿童的血液和尿液,测定尿α_(1)微球蛋白(α_(1)-MG)作为肾小管损伤标志物,分析性别、年龄、病程、血糖控制、尿微量白蛋白尿肌酐比值(albumin-to-creatinine,ACR)及糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)等情况对患儿肾小管功能的影响。结果T1DM患儿的尿ACR和α_(1)-MG水平高于正常对照组儿童。T1DM患儿中尿液α_(1)-MG水平随着HbA1c和ACR水平升高而升高,尤其是HbA1c≥10%时明显升高,并且在正常白蛋白尿时也可出现α_(1)-MG升高。T1DM合并DKA患儿的尿液α_(1)-MG水平也明显升高,α_(1)-MG≥6 mg/L的比例达到68%。结论T1DM患儿中存在肾小管损伤,与性别、病程无关,与血糖控制、是否合并DKA及尿ACR水平有关。

Objective To investigate the urinary level of biomarkers of renal tubular dysfunction in children with type 1 diabetes mellitus(T1DM)and to explore the influencing factors of renal tubular dysfunction.Methods A total of 95 hospital patients with T1DM and 50 normal controls were enrolled and the blood and urine samples were collected.The urinary level ofα_(1)-microglobulin(α_(1)-MG)were dectected as biomarker of renal tubular dysfunction,then the effects of gender,age,duration,diabetes control,albumin-to-creatinine(ACR)and diabetic ketoacidosis(DKA)on renal tubular function were analyzed.Results The urinary levels of ACR andα_(1)-MG in T1DM were significantly higher than those in normal control group.Then the urinary level ofα_(1)-MG in T1DM was increased with the increase of HbA1c and ACR,especially when HbA1c≥10%,and it can also appear in normal albuminuria.Finally,the urinary level ofα_(1)-MG in T1DM complicated with DKA was also increased significantly,the proportion of increasedα_(1)-MG reaches 68%.Conclusion There is renal tubular injury in children with T1DM,which is not related to gender and duration,but related to blood glucose control,DKA and urinary ACR level.