2型糖尿病早期肾病肾小球及肾小管功能改变

Changes of Glomerular and Tubular Function in Early Diabetic Nephropathy of Type 2 Diabetes

目的 观察 2型糖尿病早期肾病时肾小球及肾小管功能的变化。方法 对 5 5名 2型糖尿病早期肾病的患者及 2 0名健康人进行左旋精氨酸 (L -Arg)抑制试验 ,测定静脉滴注L -Arg前后的尿白蛋白排泄率(UAE1,UAE2 )及尿α1-微球蛋白 (α1-MG) ,并计算肾小管对白蛋白的重吸收率 (RA)。结果 在静脉滴注L -Arg后 ,⑴A组 (UAE :0～ 2 0 μg/min)糖尿病人UAE2 与对照组无区别 (P >0 0 5 ) ,RA较对照组低 (P <0 0 5 ) ,尿α1-MG较对照组高 (P <0 0 5 ) ;⑵B组 (UAE :2 1～ 10 0 μg/min)及C组 (UAE :10 1～ 2 0 0 μg/min)糖尿病人UAE2 均较对照组显著升高 (P <0 0 1) ,RA进一步降低 (P <0 0 1) ,尿α1-MG进一步升高 (P <0 0 1)。结论 早期糖尿病肾病患者同时存在肾小球滤过功能及肾小管重吸收功能的障碍。在糖尿病肾病的发生发展中 ,肾小管功能的受损可能要早于肾小球功能的损害。L -Arg抑制试验是一项简便实用的功能试验 ,可用于早期诊断糖尿病肾病 ,RA及尿α1-MG是反映肾小管功能的两项较敏感的指标。

Objective To assess changes of glomerular and tubular function in early diabetic nephropathy of type 2 diabetes.Methods L-arginine inhibition test of 55 patients with early diabetic nephropathy and 20 healthy control subjects were carried out,urine albumin excretion rate(UAE 1,UAE 2) and urine α 1-MG were determined before and after an intravenous infusion of L-arginine,and counted albumin reabsorption rate(RA) of renal tubules.Results ⑴no significant change of UAE 2 was found between group A(UAE:0～20μg/min) and control group(P>0 05),RA was lower(P<0 05) and α 1-MG was higher(P<0 05) than that in control group after L-arginine infusion;⑵UAE 2 in group B(UAE:21～100μg/min)and group C(101～200μg/min) was significantly hgher than that in control group(P<0 01),RA was further lower(P<0 01) and α 1-MG was further higher than that in control group(P<0 01).Conclusions There existed function involvement of glomerular filter ability and tubular reabsorption in early diabetic nephropathy of type 2 diabetes.In the developing course of diabetic nephropathy,tubular involvement may precede the glomerular lesion.L-arginine inhibition test is a simple and practical functional test,which may be used in early diagnosis of diabetic nephropathy.Albumin reabsorption rate of renal tubules and urine α 1-MG are both sensitive markers reflecting renal tubular function.