尿足细胞标志蛋白Podocalyxin检测在糖尿病肾脏损害程度评估中的意义

目的探讨尿液足细胞表面标志蛋白Podocalyxin(PCX)检测在糖尿病肾脏损害程度评估中的意义。方法选取97例2型糖尿病患者及30例健康体检者(正常对照组)。按照尿清蛋白排泄率(UAER)及血清肌酐(SCr)水平,将97例糖尿病患者分为4组:Ⅰ组,UAER<30 mg/24 h,SCr≤135μmol/L,27例;Ⅱ组,UAER为30～299 mg/24 h,SCr≤135μmol/L,29例;Ⅲ组,UAER≥300 mg/24 h,SCr≤135μmol/L,22例;Ⅳ组,UAER≥300mg/24 h,SCr>135μmol/L,19例。采用酶联免疫吸附试验(ELISA)法检测5组受检者尿液中PCX水平,分析尿液中PCX与UAER、尿蛋白定量的关系。结果与正常对照组比较,Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组糖尿病患者糖化血红蛋白(HbA1c)、尿中PCX、UAER显著升高(P<0.05),Ⅱ组、Ⅲ组、Ⅳ组SCr、尿蛋白定量亦显著升高(P<0.05);且随着糖尿病肾病的进展,Ⅰ组、Ⅱ组、Ⅲ组和Ⅳ组尿液中PCX分别为(5.8±1.0)μg/L、(15.3±4.3)μg/L、(28.9±9.0)μg/L和(23.3±10.6)μg/L,Ⅰ组、Ⅱ组、Ⅲ组组间两两比较,差异均有统计学意义(P<0.05),Ⅲ组与Ⅳ组比较差异无统计学意义(P>0.05)。相关分析显示,尿液中PCX与UAER、尿蛋白定量均呈正相关(r值分别为0.78和0.58,P均<0.01)。结论尿液PCX检测可反映糖尿病肾病的进展。

Clinical Significance of Urinary Podocyte Marker Protein Podocalyxin in the Assessment of Diabetic Nephropathy Level

Objective To investigate the significance of urinary podocyte marker protein podocalyxin(PCX) in the assessment of the level of type 2 diabetic nephropathy.Methods 97 patients with type 2 diabetes mellitus(T2DM) and 30 healthy controls(control group) were selected.The 97 T2DM patients were divided into four groups according to urine albumin excretion rate(UAER) and SCr level.Group Ⅰ:UAER<30 mg/24 h,SCr≤135 μmol/L,27 cases.Group Ⅱ:30 mg/24 h≤UAER<299 mg/24 h,SCr≤135 μmol/L,29 cases.Group Ⅲ:UAER≥300 mg/24 h,SCr≤135 μmol/L,22 cases.Group Ⅳ:UAER≥300 mg/24 h,SCr>135 μmol/L,19 cases.The levels of PCX in the five groups were detected by enzyme-linked immunosorbent assay(ELISA) to analyze the correlation between PCX,UAER and urinary total protein.Results Compared with the control group,the levels of HbA1c,PCX and UAER were significantly increased in groupⅠ,groupⅡ,group Ⅲ and group Ⅳ(P<0.05).The levels of SCr and urinary total protein in group Ⅱ,group Ⅲ and group Ⅳ were also significantly increased(P<0.05).With the progression of T2DM,the levels of PCX in groupⅠ,group Ⅱ,group Ⅲ and group Ⅳ were(5.8±1.0)μg/L,(15.3±4.3)μg/L,(28.9±9.0)μg/L and(23.3±10.6)μg/L respectively,and the pair-wise difference between groupⅠ,group Ⅱ and group Ⅲ was statistically significant(P<0.05),but the difference between group Ⅲ and group Ⅳ was not statistically significant(P>0.05).Correlation analysis showed that PCX was positively correlated with UAER and urinary total protein in T2DM patients(r=0.78 and 0.58,P<0.01).Conclusion The detection of Urinary PCX is important in the early diagnosis of diabetic nephropathy and can reflect the progression of diabetic nephropathy.