不同尿白蛋白排泄率2型糖尿病患者尿白蛋白片段的变化

目的探讨不同尿白蛋白排泄率（UAER）的2型糖尿病患者尿白蛋白片段（UAF）的变化及其意义。方法选择正常对照组20例和2型糖尿病组60例，根据UAER将糖尿病患者分为正常白蛋白尿组（22例）、微量白蛋白尿组（20例）和临床蛋白尿组（18例）。采用免疫印迹法测定UAF，并测定其积分密度值，计算相对排泄率。结果UAF阳出率及相对排泄率在对照组、糖尿病三组间差异有显著性。45KDa UAF可见于正常白蛋白尿的糖尿病患者。UAF相对排泄率与UAER、病程、收缩压、总胆固醇、甘油三酯和血浆肌酐呈正相关。多元回归分析显示影响UAF相对排泄率的因素为UAER、收缩压、甘油三酯。结论UAF可能是尿微量白蛋白出现前预测2型糖尿病肾损伤更为早期的指标，并反映了糖尿病肾病的严重程度；UAF可能与内皮功能障碍、糖尿病大血管病变有关。

Changes of urinary albumin fragments of type 2 diabetes mellitus patients with different urinary albumin excretion rate

[Objective] To investigate the changes and meaning of urinary albumin fragments (UAF) of type 2 diabetes mellitus patients with different urinary albumin excretion rate (UAER). [Methods] 20 normal controls and 60 patients with type 2 diabetes mellitus were investigated. According to UAER, patients were divided into normal albuminuria group(22), microalbuminuria group(18) and clinical albuminuria group(20). UAF were analyzed with Western Blot, integrated density value were determined and relative excretion rate was counted. [Results] There were significant differences in positive rate and relative excretion rate of UAF among control group and the three DM groups. 45 KDa UAF were detected in diabetic patients with normal albuminuria. Relative excretion rate of UAF had positive correlation with UREA, course of disease, systolic pressure, total cholesterol, triglyceride and plasma creatinine. Multivariate regression analysis showed that the factors affected relative excretion rate of UAF were UREA, systolic pressure and triglyceride. [Conclusion] UAF may be a much earlier index to indicate type 2 diabetes mellitus kidney scathe before the appearance of microalbuminuria. It also reflects the severity degree of diabetic nephropathy. UAF may be related with endothelium function disorder and big vessel disease of diabetes mellitus.