糖尿病肾脏疾病患者肾小管损伤标志物与蛋白尿的相关性分析

Correlation between markers of renal tubular injury and proteinuria in patients with diabetic kidney disease

目的 分析糖尿病肾脏疾病患者肾小管损伤标志物与24 h尿蛋白定量(24 h urine total protein quantification,24 hUTP)、尿微量白蛋白/肌酐比值(albumin creatinine ratio,ACR)之间的相关性,进而探讨糖尿病肾脏疾病患者肾小管损伤与肾小球损伤之间的关系,为糖尿病肾脏疾病的临床诊治提供指导。方法 选取2019年11月1日至2020年12月31日中国中医科学院望京医院门诊及病房明确诊断为糖尿病肾脏疾病的有蛋白尿的患者118例,同时检测患者24 hUTP、ACR、血肌酐、尿N-乙酰-β-D-氨基葡萄糖苷酶、α1-微球蛋白、视黄醇结合蛋白、肾损伤因子1,采用CKD-EPI公式计算肾小球滤过率。采用直线相关分析研究近端肾小管损伤标志物、肾小管重吸收功能与24 hUTP和ACR的相关关系。结果 118例24 hUTP在0.5~3.5 g的糖尿病肾脏疾病患者中,尿N-乙酰-β-D-氨基葡萄糖苷酶、肾损伤因子1、α1-微球蛋白、视黄醇结合蛋白均与24 hUTP成线性相关,相关系数(调整R^(2))分别是0.192、0.079、0.054、0.040,近端肾小管损伤标志物与24 hUTP的相关性更高。尿N-乙酰-β-D-氨基葡萄糖苷酶、肾损伤因子1、α1-微球蛋白、视黄醇结合蛋白分别与ACR成线性相关,相关系数(调整R^(2))分别是0.367、0.058、0.077、0.076,近端肾小管损伤标志物与ACR的相关性更好。结论 在糖尿病肾脏疾病患者中,肾小管损伤标志物与24 hUTP、ACR成线性相关,其中近端肾小管损伤标志物与24 hUTP和ACR的相关性更好,肾小管损伤与糖尿病肾脏疾病的进展关系密切。

Objective To explore the correlation between markers of tubular injury,24 h urine protein quantification(24 hUTP)and albumin creatinine ratio(ACR)in patients with diabetic kidney dis-ease(DKD)and explore the relationship between tubular and glomerular injuries to provide guidance for clinical management of DKD.Methods From November 1,2019 to December 31,118 proteinuric pa-tients with a definite diagnosis of DKD at outpatient clinic and ward were recruited.And 24 hUTP,ACR,blood creatinine,urinary N-acety1-β-D-glucosaminidase,alpha 1 microglobulin,retinol-binding protein and kidney injury molecule-1 were measured and estimated glomerular filtration rate(eGFR)calculated by the CKD-EPI formula.Linear correlation analysis was utilized for examining the correlation between markers of proximal tubular injury,tubular reabsorption function and 24 hUTP and ACR.Results 24 hUTP at(0.5-3.5)g/24 h,urinary N-acety1-β-D-glucosaminidase,kidney injury molecule-1,alpha 1 mi-croglobulin,retinol-binding protein were correlated linearly with 24 hUTP.The correlation coefficients(adjusted R^(2))were 0.192,0.079,0.054 and 0.040 respectively.Proximal renal tubular injury markers had the highest correlation with 24 hUTP.Urinary N-acety1-β-D-glucosaminidase,kidney injury molecule-1,alpha 1 microglobulin and retinol-binding protein were correlated linearly with ACR.The correlation coef-ficients(adjusted R^(2))were 0.367,0.058,0.077 and 0.076 respectively with the best correlation between proximal tubular injury markers and ACR.Conclusions In DKD patients,renal tubular injury markers are correlated linearly with 24 hUTP and ACR.Proximal tubular injury markers have the best correlations with 24 hUTP and ACR.Renal tubular injury is correlated closely with the progression of DKD.