2型糖尿病患者血清与尿铜蓝蛋白水平的变化

Changes in serum and urine ceruloplasmin concentrations in type 2 diabetes

目的 :检测 2型糖尿病患者血清与尿铜蓝蛋白 (Cp)浓度的变化及探讨临床意义。方法 :采用放射免疫法与速率散射免疫浊度法检测 5 7份血清Cp ,并采用速率散射免疫浊度法检测 1 1 0例健康对照组 ,1 0 4例 2型糖尿病患者血清Cp ,尿Cp与肌酐 (Cr)比值及尿白蛋白 (Alb)与Cr比值。将 2型糖尿病患者分为血糖控制良好组与血糖控制不良组 ,糖尿病肾病组与无糖尿病肾病组进行分析与比较。结果 :放射免疫法与速率散射免疫浊度法检测血清Cp相关性与可比性良好 ;血清Cp的正常参考上限为 5 4 2mg/L(1 1 0例健康人的 97.5 %可信区间 ) ,尿Cp/Cr的正常参考上限为 0 .892ng/mmol(1 1 0例健康人的 97.5 %百分位点 ) ;2型糖尿病患者血清Cp值显著高于健康对照组 (P <0 .0 0 1 ) ,其中血糖控制不良组血清Cp值显著高于血糖控制良好组 (P <0 .0 1 ) ,有糖尿病肾病组尿Cp/Cr显著高于无糖尿病肾病组 (P <0 .0 0 1 ) ;尿Cp/Cr对糖尿病肾病的诊断敏感性为 91 .4 % ,特异性为 6 1 .4 % ,符合率为 75 .0 %。结论 :检测血清Cp水平对于了解糖尿病的病情有一定参考价值 。

Objective To determine the changes in serum and urine ceruloplasmin (Cp) concentrations in type 2 diabetes, and to explore its clinical significance. Methods Cp concentrations of 57 serum samples were measured by radioimmunoassay and ratenephelometry. In the meantime, the serum and urine Cp concentrations in 110 healthy individuals and 104 type 2 diabetic patients were determined by ratenephelometry. For analysis and comparison, 104 type 2 diabetic patients were divided into imperfect glycemic control subgroup ( n =54) and perfect glycemic control subgroup ( n =50), diabetic nephropathy subgroup ( n =47) and non diabetic nephropathy subgroup ( n =57).Results Serum Cp concentrations obtained with the radioimmunoassay and ratenephelometry methods were highly correlated and essentially indistinguishable. The cut off point of the serum Cp concentrations was 542 mg/L and that of the ratio of Cp and creatinine was 0.892 ng/mmol, which was determined according to the upper limit of 97.5% credit intervals or 97.5% percentile in 110 healthy individuals. Cp concentrations in type 2 diabetic patients were significantly higher than those in the healthy individuals ( P <0.001). Of the type 2 diabetic patients, the imperfect glycemic subgroup had higher serum Cp concentrations than those of the perfect glycemic subgroup ( P <0.01). The urine ratio of Cp and creatinine in diabetic nephropathy subgroup was significantly higher than that in non diabetic nephropathy subgroup (P<0.001). Urine ratio of Cp and creatinine in diagnosing diabetic nephropathy had 91.4% of sensitivity, 61.4% of specificity, and 75.0% of concordance.Conclusion Detection of serum Cp levels has some reference value in understanding the state of diabetes.Combined determination of urine ratio of Cp and creatinine and ratio of albumin and creatinine is significant in the early diagnosis of diabetic nephropathy.