血清Ⅳ型胶原和层粘连蛋白在2型糖尿病肾病中的临床价值

Clinical value of the joint measurement of serum concentrations of type Ⅳ collagen and laminin in patients with diabetic nephropathy

目的 探讨血清Ⅳ型胶原 (ⅣC)和层粘连蛋白 (LN)在 2型糖尿病 (DM)肾病中的临床价值。方法 78例 2型DM患者 (男 4 2例 ,女 36例 )分为正常白蛋白尿组 (A组 ) 35例 ,微量白蛋白尿组 (B组 ) 2 8例和大量白蛋白尿组 (C组 ) 15例。采用放射免疫分析法测定其血清ⅣC和LN含量。对照组为健康体格检查者 30例。结果 78例DM患者血清ⅣC[(97 6± 19 2 ) μg/L]、LN[(132 4±31 5 ) μg/L]水平明显高于对照组 [(77 4± 8 2 )、(10 1 5± 17 6 ) μg/L ,P <0 0 5 ];微量及大量白蛋白尿组患者血清ⅣC、LN水平均明显高于对照组 (P <0 0 5 ,P <0 0 1) ;DM各组间血清ⅣC、LN水平差异有显著性 ,随 2 4h尿白蛋白排泄率 (UAER)增加及病程延长 ,血清ⅣC、LN水平递增 ,病程 >10年者 [ⅣC(10 6 6± 2 0 1) μg/L ,LN (14 5 3± 31 1) μg/L]明显高于病程 <5年者 [(89 4± 17 5 ) μg/L ,(117 8±2 7 4 ) μg/L ,P <0 .0 5 ];血清ⅣC、LN与病程、尿素氮 (BUN)、肌酐 (Cr)、UAER呈高度正相关。 结论 联合检测血清ⅣC、LN、UAER能为早期诊断和治疗DM肾病提供依据 ,并可用于判断预后。

Objective To study clinical value of the joint measurement of serum concentrations of type Ⅳ collagen (ⅣC) and laminin (LN) in patients with diabetic nephropathy (DN) by radioimmunoassay (RIA). Methods Serum concentrations of ⅣC,LN were measured by RIA in 35 diabetic patients with normalbuminuria (group A),28 cases of microalbuminuria (group B),15 cases of macroalbuminuria (group C) and 30 normal subjects as control. Results The serum concentrations of ⅣC,LN in total 78 diabetic patients [(97.6±19.2),(132.4±31.5) μg/L] were higher than that of the controls [(77.4±8.2),(101.5±17.6) μg/L,P <0.05],especially in group B and C,it was remarkablely higher compared with the controls ( P <0.05,P <0.01). There was significant positive correlation of serum ⅣC,LN to diabetic duration and the levels of blood urea nitrogen (BUN),creatinine (Cr),urinary albumin excretion rate (UAER). Conclusions The results suggest that the joint measurement of serum levels of ⅣC,LN and UAER in DN patients might better evaluate the development process of DN,and be of help for early diagnosis and treatment of DN. Serum levels of ⅣC,LN and UAER in DN patients may become the reliable clinical markers for assessing the severity and predicting the prognosis of DN.