尿Smad1与2型糖尿病肾病早期诊断及病情进展关系的探讨

目的  探讨尿Smad1与2型糖尿病肾病早期诊断及病情进展之间的关系。方法  选取广州中医药大学第一附属医院内分泌科和暨南大学第一附属医院内分泌科166例2型糖尿病患者。按尿微量白蛋白与肌酐比值分为正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组。并以80例健康体检者作为对照组。采用酶联免疫吸附法检测尿标本中Smad1浓度，并以尿Smad1与尿肌酐（SCR）作为标准数值，SCR取对数值。结果  正常白蛋白尿组SCR与对照组比较差异无统计学意义（P >0.05）；微量白蛋白尿组SCR较正常白蛋白尿组高（P <0.05）；大量白蛋白尿组SCR较微量白蛋白尿高（P <0.05）。Pearson相关分析显示，SCR与HbA1c、病程、视网膜病变呈线性正相关（r =0.384、0.413和0.325，P =0.000、0.005和0.021）；ROC曲线显示，尿Smad1是诊断2型糖尿病肾病的较好指标。结论  尿Smad1可作为2型糖尿病肾病早期诊断的新型指标，并可反映糖尿病肾病病情进展。

Relationship of urinary Smad1 with early diagnosis and progression of diabetic nephropathy in type 2 diabetes patients

Objective To explore the relationship of urinary Smad1 with early diagnosis and progression of diabetic nephropathy in type 2 diabetes patients. Methods In this study 166 subjects with type 2 diabetes and 80 healthy volunteers were enrolled. The patients were divided into three groups according to urine albumin to creatinine ratio, i.e. normal albuminuria group, microalbuminuria group and macroalbuminuria group. The 80 healthy volunteers were the controls. Enzyme-linked immunosorbent assay was used to detect the urinary Smad1 concentration. Urinary Smad1 to creatinine ratio (SCR) was used as the standard reference. Results The SCR in the microalbuminuria group was higher than that in the normal albuminuria group (P < 0.05). SCR of the macroalbuminuria group was higher than that of the microalbuminuria group (P < 0.05), while there was no difference between the normal albuminuria group and controls (P > 0.05). Pearson correlation analysis showed that SCR was positively correlated to HbA1c, duration and diabetic retinopathy of the disease (r = 0.384, 0.413 and 0.325; P = 0.000, 0.005 and 0.021, respectively). ROC curve showed that urinary Smad1 is a good indicator for early diagnosis of type 2 diabetic nephropathy. Conclusions Urinary Smad1 may be a new early diagnostic indicator for diabetic nephropathy and could reflect the progression of diabetic nephropathy.