尿微量白蛋白在糖尿病肾病早期诊断中的临床价值

目的探讨分析尿微量白蛋白(m A1b)用于早期诊断在糖尿病肾病的临床价值。方法收集早晨中段尿,分别测定该社区卫生服务中心2011年1月—2014年6月收治的80例糖尿病肾病患者(研究组)和具有可比性的80名健康体检者(对照组)的尿微量白蛋白。结果 80名的糖尿病肾病患者的阳性率明显高于健康体检者,两组相比较P0.05,差异有统计学意义。结论尿微量白蛋白在早期糖尿病肾病中的临床应用具有重要的诊断价值。     

尿微量白蛋白在糖尿病肾病早期诊断中的临床价值

目的探讨分析尿微量白蛋白（m A1b）用于早期诊断在糖尿病肾病的临床价值。方法收集早晨中段尿,分别测定该社区卫生服务中心2011年1月—2014年6月收治的80例糖尿病肾病患者（研究组）和具有可比性的80名健康体检者（对照组）的尿微量白蛋白。结果 80名的糖尿病肾病患者的阳性率明显高于健康体检者,两组相比较P〈0.05,差异有统计学意义。结论尿微量白蛋白在早期糖尿病肾病中的临床应用具有重要的诊断价值。     

糖尿病肾病血心纳素变化与尿白蛋白的关系

选择糖尿病无肾病组，微量蛋白尿组，临床蛋白尿组与正常组对照研究。结果血浆心钠素水平在大量蛋白尿时明确升高，而在无肾病及微量蛋白尿时正常，结论 血浆心钠素可能在糖尿病肾病中影响肾小球滤过率，同时可增加尿白蛋白排泄。     

^99mTc-DTPA核素肾动态显像对糖尿病肾病的早期诊断价值

目的探讨99mTc-DTPA核素肾动态显像对糖尿病肾病（DN）的早期诊断价值及其影响因素。方法选择90例DN患者,根据尿微量白蛋白（mAlb）分为正常白蛋白尿组（NA组）、微量白蛋白尿组（MA组）、大量白蛋白尿组（MAA组）各30例,同期选择30例健康体检者作为对照组（NC组）,均行99mTc-DTPA核素肾动态显像法测定各组患者肾小球滤过率（GFR）,并对其相关影响因素进行分析。结果①尿mAlb、血肌酐（Scr）未见异常时,总肾和分肾GFR即可出现异常（P〈0.05或〈0.01）,其较常见的是GFR均下降,但有5例是GFR均升高。②11例患者mAlb及总肾GFR均正常,但分肾GFR已经出现异常。③GFR与病程、收缩压、HbA1c、Scr呈显著负相关（r=-0.456、-0.143、-0.172、-0.472,P〈0.05或〈0.01）。总肾、左右肾GFR与mAlb均呈显著负相关（r=-0.456、-0.406、-0.423,P均〈0.01）。结论 GFR较mAlb、Scr能更早、更灵敏、更准确地反映DN,而99mTc-DTPA核素肾动态显像测定GFR具有简便、无创等优点,可作为DN早期诊断的重要手段。     

尿蛋白质组学检测在糖尿病肾病早期诊断中的价值

目前在临床上主要以尿门蛋白或用血肌酐计算的肾小球滤过率来诊断和评估糖尿病肾病（DN），尚无早期诊断DN的敏感指标。前期研究发现尿胶原代谢的改变与肾脏损伤关系密切，在尿白蛋白分泌增多之前，尿中胶原蛋白片段分泌异常。     

分析尿液微量白蛋白测定在糖尿病肾病的临床使用价值

目的探究尿液微量白蛋白测定在糖尿病肾病的应用价值。方法选取2010年3月—2012年2月在该院进行治疗的62例糖尿病肾病患者作为对照组,另外选取62名健康人群作为观察组,清洁容器留取早晨中段尿10 m L,3 000 r/min,离心10 min后,取上清液体。结果对照组尿液微量白蛋白水平（52±18）mg/L,观察组尿液微量白蛋白水平（18±12）mg/L,差异有统计学意义（P〈0.05）。讨论糖尿病患者的尿液微量白蛋白明显高于健康组,尿液微量白蛋白的测定是诊断糖尿病肾病的实验室指标之一,对阻止和延缓糖尿病肾病的发展有重要的意义。     

尿蛋白及尿微量白蛋白在糖尿病早期肾病中的临床检验价值

目的 探讨尿蛋白及尿微量白蛋白联合检测对糖尿病早期肾病的临床检验价值。方法 选取2022年1—12月三明市第二医院就诊收治的26例糖尿病早期肾损伤（Early Diabetic Nephropathy, EDN）患者纳入EDN组,选择同期就诊治疗的26例单纯糖尿病（Diabetes Mellitus, DM）患者纳入DM组,同时将体检中心26例体检健康者纳入对照组。比较各组患者尿蛋白、尿微量白蛋白（Urinary Microalbumin, UMA）水平,分析单一指标与联合指标检测的灵敏度、特异度、准确度水平,绘制受试者工作（Receiver Operating Characteristic Curve, ROC）曲线并评估曲线下面积（Area Under the Curve, AUC）。结果 EDN组患者尿蛋白及UMA水平均高于DM组与健康组,DM组尿蛋白及UMA水平高于健康组,差异有统计学意义（P均<0.05）;联合检测组检测灵敏度（92.31%）高于单一检测组,差异有统计学意义（P均<0.05）,联合检测组AUC值0.902(95%CI 0.837～0.966)高于单...     

ACR在糖尿病肾病患者诊断中的临床意义

目的 探讨尿微量白蛋白/尿肌酐比值（albumin/urine creatinine ratio, ACR）在糖尿病肾病（diabetic nephropathy, DN）中的应用价值。方法 选取2020年5月—2022年5月鸡西鸡矿医院收治的55例DN患者作为DN组,另选同期2型糖尿病（diabetes mellitus type 2, T2DM）患者55例作为T2DM组。采集所有入选对象尿液标本,检测尿微量白蛋白（microalbuminuria, MALB）、尿肌酐（urinary creatinine, UCR）及MALB/UCR（ACR）。比较两组MALB、UCR及ACR水平,并绘制ROC曲线风险MALB、UCR及ACR诊断DN的临床价值。结果 DN组的MALB为（108.59±7.25）mg/L、UCR水平（2.72±0.27）g/d、ACR水平（39.92±3.54）mg/g,均高于T2DM组,差异有统计学意义（P<0.05）;绘制ROC曲线显示,MALB、UCR、ACR诊断DN的曲线下面积（AUC）分别为0.783、0.698、0.926,ACR诊断价值最高。结论...     

尿转铁蛋白测定在糖尿病肾病早期诊断中的临床意义

目的探讨尿转铁蛋白(TRF)在糖尿病肾病(DN)早期诊断中的临床意义。方法分正常人组及糖尿病组,留取晨新鲜尿测定对比尿微量白蛋白(UAER)及转铁蛋白(TRF)。结果糖尿病病人中蛋白尿组和尿微量白蛋白正常组转铁蛋白升高者分别为100%、26.5%,差异有非常显著意义(PO.01)。结论转铁蛋白可以作为更敏感的糖尿病肾病早期诊断指标。     

探讨尿蛋白和尿微量白蛋白在糖尿病肾病检验中的应用价值

目的:在糖尿病肾病检验中尿蛋白和尿微量白蛋白指标的应用价值做分析.方法:试验时间为2020年3月至2021年3月,取糖尿病肾病群体共39例作为研究组,并在同时期取健康人员39例作为参照组,所有研究对象均接受尿蛋白、尿微量白蛋白指标检测,并对其指标检测结果进行比对.结果:研究组中尿蛋白阳性患者的人数明显多于参照组,数据之...     

不同肾脏大小指标对“亚临床”糖尿病肾病高滤过期的筛查价值

在“亚临床”糖尿病肾病(DN)肾小球高滤过期,各项肾脏大小指标均明显增大,并且其改变早于微量白蛋白尿出现之前.受试者工作特征(ROC)曲线分析提示肾小球高滤过的肾脏长径界值为10.53 cm,其灵敏度最佳,特异度和总符合率均较高,对筛查早期DN肾小球高滤过期有一定临床价值.     

Monitoring kidney function in diabetic nephropathy

We investigated the validity of a one plasma sample method (I) compared with a multiple plasma sample method (II) for routine clinical determination of glomerular filtration rate (GFR) in 35 insulin-dependent diabetic patients suffering from nephropathy. GFR was measured after an intravenous bolus injection of 100 microCi 51Cr-EDTA by determination of plasma radioactivity in venous blood samples taken from the other arm 180, 200, 220 and 240 min after the injection (II). The plasma radioactivity in the sample drawn 240 min after injection was used in method I. During the mean investigation period of 32 months (12-62 months) a total of 184 GFR determinations were performed. The average interval between the GFR measurements was 6 months (1-21 months). In 127/184 of the study intervals method I indicated a decrease in GFR. The corresponding figure for method II was almost identical, 130/184. The mean decline in GFR was 8.1 +/- 7.2 and 7.8 +/- 6.9 ml year-1 1.73 m-2 using methods I and II, respectively (NS). The methods essentially provided the same GFR values in absolute terms (r = 0.98, P less than 0.001). We conclude that the one plasma sample method can be used as a valid routine technique in non-uraemic patients with nephropathy.     

肾小球滤过率和肾有效血浆流量"分离现象"对诊断早期糖尿病肾病的意义

目的探讨肾小球滤过率(GFR)和肾有效血浆流量(ERPF)的变化对诊断早期糖尿病肾病(DN)的意义。方法根据尿白蛋白排泄率(UAER)将105例2型糖尿病(T2DM)患者分为3组:无DN(NDN)组,早期DN(EDN)组,临床DN(CDN)组。用SPECT测定GFR、ERPF值,并测定尿白蛋白(UAlb)、尿免疫球蛋白G(UIgG)、α1微球蛋白(Uα1-MG)、β2微球蛋白(Uβ2-MG)、血清肌酐(SCr)和尿素氮(BUN)。结果NDN组GFR和ERPF值增高,与UAlb负相关;EDN组GFR增高与UAlb正相关,ERPF低于正常对照组,与UAlb负相关,出现GFR和ERPF"分离现象";CDN组GFR和ERPF明显降低,与UAlb负相关。UAlb、UIgG、Uα1-MG、Uβ2-MG与SCr、BUN正相关。结论核素显像测定GFR、ERPF"分离现象"能够及时反映糖尿病的早期肾脏损害,与UAlb联合检测有助于了解DN的病变程度。     

Plasma lipoproteins and renal function during simvastatin treatment in diabetic nephropathy

Summary The aim of this study was to assess the effect of simvastatin on plasma lipoproteins and renal function in hypercholesterolaemic Type 1 (insulin-dependent) diabetic patients with diabetic nephropathy. Twenty-six hypercholesterolaemic (total cholesterol ≽ 5.5 mmol/l) Type 1 diabetic patients with nephropathy were enrolled in a double-blind randomized placebo-controlled study for 12 weeks. The active treatment group (n -14) received simvastatin (10–20 mg/day) for 12 weeks while the remaining 12 patients received treatment with placebo. The results during simvastatin treatment (baseline vs 12 weeks): total cholesterol 6.6 vs 4.8 mmol/1 (p < 0.01), LDL-cholesterol 4.25 vs 2.57 mmol/l (p < 0.01) and apolipoprotein B 1.37 vs 1.06 mmol/l (p < 0.01). HDL-cholesterol, and apolipoprotein A-I remained unchanged. Total cholesterol, LDL-cholesterol, HDL-cholesterol, apolipoprotein A–I, apolipoprotein B remained unchanged during placebo treatment. Albuminuria measured during the simvastatin and the placebo treatment (baseline vs 12 weeks) (the data are logarithmically transformed before analysis because of their positively skewed transformation; geometric mean (×/÷ antilog SE) is indicated) was 458 (×/÷ 1.58) vs 393 (×/÷ 1.61) and 481 (×/÷ 1.62) vs 368 (×/÷ 1.78 μg/min (NS). Glomerular filtration rate during simvastatin and placebo treatment (baseline vs 12 weeks) was 64 vs 63 and 72 vs 74 ml·min⁻¹·1.73 m⁻², respectively. Two patients receiving simvastatin treatment were withdrawn, one due to gastrointestinal side effects and one due to myalgia. In conclusion, our short-term study in Type 1 diabetic patients with diabetic nephropathy did not reveal any beneficial effect on albuminuria despite a striking lipid-lowering effect of simvastatin in diabetic nephropathy.     

血清胱抑素C与糖尿病肾病

血清胱抑素C是一种半胱氨酸蛋白酶抑制剂,由机体所有有核细胞以恒定的速率产生,其相对分子质量小,可被肾小球自由滤过,在近端肾小管被代谢.血清胱抑素C作为一种内源性标志物,可以较早的反映肾小球滤过率的变化,故其在糖尿病肾病早期诊断中有重要的价值.     

Monitoring kidney function in diabetic nephropathy

Summary Progression in diabetic nephropathy is usually determined by repeated measurements of glomerular filtration rate and expressed as rate of decline in glomerular filtration rate. Our aim was to evaluate the agreement between rate of decline in glomerular filtration rate estimated from the Cockroft-Gault formula: (140-age)^*K^*body weight^* (1/S-creatinine) and measured by the plasma clearance of ⁵¹CrEDTA. All insulin-dependent diabetic patients with diabetic nephropathy followed-up for at least 5 years with at least 5 simultaneous measurements of glomerular filtration rate, s-creatinine, and weight were included in the study. Forty-three patients (32 male/11 female), age 31 (18–61) years were enrolled. Observation period: 6.6 (5.1–9.9) years and number of investigations per patient 6 (5–16) (median(range)). Baseline glomerular filtration rate (ml/min) was 97 (30) measured and 107 (37) estimated (mean(SD))(p<0.001) and the 95% limits of agreement were –42.0 to 20.8 ml/min. Measured and estimated glomerular filtration rate correlated significantly (r = 0.91, p<0.00001). Rate of decline in kidney function ml · min^–1 · year^–1 was 4.7 (3.3) measured and 4.8 (3.5) estimated (mean(SD)) (NS), but the 95% limits of agreement showed a wide range –3.9 to 3.5 ml · min^–1 · year^–1. A significant correlation between rate of decline in measured and estimated glomerular filtration rate was present (r = 0.84, p<0.00001). In conclusion, glomerular filtration rate is overestimated by the Cockroft-Gault formula. The mean rates of decline in glomerular filtration rate are comparable, but the limits of agreement are wide, which make the Cockroft-Gault method unacceptable for clinical purposes, i.e. monitoring progression in kidney function in the individual patient. However, the estimated glomerular filtration rate may be used for comparison of groups in observational studies and in clinical trials with a long observation period.Abbreviations GFR Glomerular filtration rate - ⁵¹Cr-ED-TA ⁵¹Chromium ethylene diamine tetra-acetic acid - IDDM insulin-dependent diabetes mellitus     

血清胱抑素C在2型糖尿病不同肾损害期的变化及其临床意义

目的探讨血清胱抑素C在2型糖尿病不同肾损害期的变化及其临床意义,比较血清胱抑素C与肾小球滤过率、尿微量白蛋白排泄率间的相关性。方法采用颗粒增强散射免疫比浊法测定102例2型糖尿病患者(其中并糖尿病肾病66例)血清胱抑素水平,同时测定肾小球滤过率和尿微量白蛋白排泄率。结果2型糖尿病正常白蛋白尿组,2型糖尿病微量白蛋白尿组及2型糖尿病大量白蛋白尿组间血清胱抑素C水平均有显著差异(P<0.01),2型糖尿病微量白蛋白尿组和2型糖尿病大量白蛋白尿组血清胱抑素C测值与肾小球滤过率有良好的相关性(P<0.05)。结论血清胱抑素C在临床上可作为肾小球滤过率的判断指标,且有助于2型糖尿病肾病的早期诊断。     

Impact of metabolic control in progression of clinical diabetic nephropathy

Summary Renal clearance of ⁵¹Cr-EDTA as a measure of glomerular filtration rate was followed prospectively for 21 months in 18 Type 1 (insulin-dependent) patients with juvenile-onset diabetes and nephropathy. Hypertension was treated aggressively, attaining a mean blood pressure of 154/88 mmHg in the supine and 126/82 mmHg in the standing position. The mean glycosylated haemoglobin value (HbA_1c) during the observation period was found to correlate well with the mean of random blood glucose values (r=0.72). It also correlated to the rate of glomerular filtration rate decline over time, whether the latter was calculated as slope coefficient for all available data (r=-0.52, p<0.05) or based on the first and last observations only (r=-0.57, p<0.05). In a multiple linear stepwise regression analysis also including mean arterial blood pressure, the correlation between glomerular filtration rate decline and HbA_1c was significant at p<0.01; this explained one-third of the progression, while mean arterial pressure could not be shown to contribute. It is concluded that hyperglycaemia, contrary to the general belief, is a risk factor for the progression of clinical diabetic nephropathy with reduced glomerular filtration rate.     

Natural course of kidney function in Type 2 diabetic patients with diabetic nephropathy.

AIMS: To determine the natural course of kidney function and to evaluate the impact of putative progression promoters in Caucasian Type 2 diabetes mellitus (DM) patients with diabetic nephropathy who had never received any antihypertensive treatment. METHODS: A long-term observational study of 13 normotensive to borderline hypertensive Type 2 DM patients with diabetic nephropathy. Glomerular filtration rate (GFR) was measured approximately every year (51Cr-EDTA plasma clearance technique). Albuminuria, blood pressure (BP) and haemoglobin A1c (HbA1c) was determined 2-4 times per year and serum cholesterol every second year. RESULTS: The patients (12 males/one female), age 56+/-9 (mean +/- SD) years, with a known duration of diabetes of 10+/-6 years, were followed for 55 (24-105) (median (range)) months. GFR decreased from 104 (50-126) to 80 (39-112) ml x min(-1) x 1.73 m(-2) (P = 0.002) with a median rate of decline of 4.5 (-0.4 to 12) ml x min(-1) x year(-1). During follow-up, albuminuria rose from 494 (301-1868) to 908 (108-2169) mg/24 h (P = 0.25), while BP, HbA1c and serum cholesterol remained essentially unchanged. In univariate analysis the rate of decline in GFR did not correlate significantly with neither baseline nor mean values during follow-up of BP, albuminuria, HbA1c and serum cholesterol. CONCLUSIONS: Our study suggests that normotensive to borderline hypertensive Type 2 DM patients with diabetic nephropathy have a rather slow decline in kidney function, but we did not unravel the putative progression promoters responsible for the variation in rate of decline in GFR.     

Rate of decline in renal function in Indo-Asians and Whites with diabetic nephropathy

The incidence of end-stage renal failure (ESRF) is higher in the Indo-Asian ethnic group as compared to the White. To investigate whether this might be associated with faster rates of progression to ESRF in Indo-Asian diabetic patients, we studied a total of 39 Type 2 diabetic patients, using the Department of Nephrology database showing serial serum creatinine measurements from the time of first referral to the clinic until they reached a level of >500 μmol l⁻¹ or ESRF requiring renal replacement therapy (RRT), either dialysis or renal transplantation. They were grouped into Indo-Asian (n = 24) and White (n = 15). The rate of progression of those who developed ESRF, calculated as the slope of log serum creatinine against time, was not significantly different between the Indo-Asian and White patients, p = 0.73. We conclude that the higher incidence of ESRF in the Indo-Asian Type 2 diabetic patient with nephropathy is therefore not due to a faster rate of deterioration in renal function. © 1998 John Wiley & Sons, Ltd.