2型糖尿病患者尿Ⅳ型胶原和尿微量白蛋白联合测定的意义

为评价尿微量白蛋白与Ⅳ型胶原对2型糖尿病患者肾功能早期损伤的诊断价值, 取正常人30名与165例2型糖尿病患者24小时的尿液, 采用放射免疫法(RIA), 同时测定尿微量白蛋白和Ⅳ型胶原(浓缩法).结果显示: (1)正常组24h尿微量白蛋白为6.45±2.04mg/24h,尿Ⅳ型胶原为86.68±11.98μg/L.(2)根据2型糖尿病患者24h尿微量白蛋白含量分为两组,A组130例, 尿微量白蛋白大于或等于30mg/24h,尿Ⅳ型胶原为120.03±34.02μg/L; B组35例, 尿微量白蛋白小于30mg/24h, 尿Ⅳ型胶原为97.14±24.93μg/L.结论: 2型糖尿病患者在尿微量白蛋白还未超过正常上限时, 已经有部分人尿Ⅳ型胶原升高, 说明尿Ⅳ型胶原比尿微量白蛋白更能体现2型糖尿病患者肾功能早期损伤.     

随机尿微量白蛋白检测对筛检早期糖尿病肾病的价值

评价随机尿白蛋白浓度检测对筛选糖尿病微量白蛋白尿的效能.198例2型糖尿病患者纳入研究,完成其24h尿样收集及白天随机尿收集.白蛋白测定采用免疫比浊法.根据24h尿白蛋白排泄率(24h UAER)分为正常白蛋白尿组(24h UAER＜20μg/min,102例)及微量白蛋白尿组(24h UAER 20-200μg/min,96例)两组.并绘制随机尿白蛋白浓度(UAC)受试者工作曲线(ROC).结果是:UAC与UAER相关(r=0.92,P＜0.001),UAC-ROC 100%敏感度截断点UAC值为15mg/L(特异度为74%),敏感度与特异度最佳截断点UAC值为30mg/L(敏感度90%,特异度89%).随机UAC对于筛选微量白蛋白尿准确性较高,且较UAER简便、经济,适用于筛检早期糖尿病肾病.     

2型糖尿病检测晨尿Alb的临床价值

目的评价测定2型糖尿病患者晨尿白蛋白(Alb)的临床价值。方法同期检测20例正常人和33例2型糖尿病患者晨尿Alb/Cr比值、Alb和α1-微球蛋白(α1-MG)浓度。结果(1)Alb/Cr≥2.5mg/mmol为早期糖尿病肾病诊断标准 ,早期糖尿病肾病组晨尿Alb较糖尿病尿白蛋白正常组显著升高 (P<0.001) ,亦较正常人显著升高(P<0.001)。(2)晨尿Alb和尿Alb/Cr在正常人或2型糖尿病人中 ,均呈正相关。结论晨尿Alb可作为监测2型糖尿病肾脏早期病变指标之一。     

尿微量白蛋白在预防和预测治疗糖尿病及高血压，心血管疾病及其它方面的探讨及分析

微量白蛋白尿是指尿液中自蛋白低浓度升高,其升高范围是20—200μg/min,20—200mg／l,或30—300mg／24h,微量白蛋白排出增加是某些疾病的早期的改变。对疾病的早期诊断。早期预防和治疗有重要的参考价值和临床意义。大量临床研究表明,尿微量白蛋白是预测糖尿病,高血压心血管疾病血管损伤的敏感指标,目前认为这项指标对早期治疗原发病,分析病程进展,评价相关危险因素有很高的临床意义。     

血清CysC检测在早期诊断2型糖尿病肾病中的意义

目的 探讨血清胱抑素C（CysC）在早期糖尿病肾病（DN）患者血液中的变化及其诊断价值.方法 对120例2型糖尿病（T2DM）患者根据尿微量白蛋白排泄率（UAER）分为两组：T2DM无蛋白尿组（UAER＜ 30mg/24h）,60例;T2DM微量蛋白尿组（UAER30 ～ 300mg/24h）,60例;用免疫比浊法检测2型糖尿病肾病患者和健康体检人群的血清CysC,速率法测定尿素氮（BUN）,酶法测定血肌酐（Scr）,并对检测结果进行统计分析.结果 60例T2DM尿微量白蛋白患者CysC、BUN、Scr的异常结果检出率分别为80.0％、10.0％、18.3％,CysC的异常结果检出率明显高于BUN、Scr.结论 血清中CysC的浓度可作为2型糖尿病肾病早期诊断指标,且对了解肾脏损伤程度也有较大的临床意义.     

TGF-β1在糖尿病肾病早期诊断中的应用

目的:探讨转化生长因子-β1(TGF-β1)在糖尿病早期肾病诊断中的临床应用价值。方法:采用放射免疫分析检测糖尿病患者血清及尿中β2-微球蛋白(β2-m),采用酶联免疫分析(ELISA)法检测糖尿病患者血清中TGF-β1。同时检测尿白蛋白(uAlb)及尿微量蛋白,按尿白蛋白的排泄率分为三组。结果:糖尿病患者TGF-β1、血β2-m、尿β2-m与尿Alb具有很好的正相关性。结论:检测血清TGF-β1、血β2-m、尿β2-m是诊断糖尿病早期肾损害的敏感指标,对糖尿病肾病的早期诊断具有一定的临床应用价值。     

尿微量白蛋白、尿酶和尿肌酐联合测定对糖尿病早期肾损害的临床价值

目的探讨尿蛋白定性阴性的糖尿病患者随机尿中尿微量白蛋白(mAlb)、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)和尿肌酐(Cr)的检测对发现糖尿病早期肾损害的临床价值。方法尿微量白蛋白(mAlb)用免疫透射比浊法,尿NAG用终点法,尿肌酐(Cr)采用Jaffe's速率法进行测定。结果尿蛋白定性阴性的糖尿病组尿mAlb/Cr,NAG/Cr分别为(8.33±6.82)mg/mmol和(24.33±17.38)U/g,对照组mAlb/Cr,NAG/Cr分别为(1.61±0.86)mg/mmol和(5.83±2.96)U/g.,两组比较具有显著性差异(P<0.01)。结论常规尿mAlb/Cr,NAG/Cr的检测可作为发现糖尿病早期肾损害敏感而又可靠的常规指标。     

两种尿微量白蛋白测定方法的临床评价

对化学发光免疫测定法(CLIA)测定尿微量白蛋白的方法进行临床评估, 旨在为尿微量白蛋白测定选择一种简便快速, 准确和特异的方法.85例糖尿病患者及80名对照均留取8h尿样本, 用CLIA和RIA法测定, 并进行比较和分析精密度, 准确性、特异性及干扰因素.结果显示CLIA和RIA两种方法均具有很好的精密度, 批内CV小于4%, 批间CV小于6%,回收率在95.1%-105.9%,且测定不受样本中γ球蛋白的影响.CLIA的最低检测浓度为2.5μmol/L.两种方法测定的尿微量白蛋白值相关较好(Y=0.9974X-0.0291),r=0.9902.结论: CLIA和RIA尿微量白蛋白测定方法均具有高精密度, 高特异性, 两种方法的结果明显相关.然而, 与RIA比较CLIA简便、快速, 没有放射性污染, 且自动化程度高, 比较适合临床常规实验室应用.     

糖尿病患者尿Alb测定的临床意义

糖尿病肾病的早期诊断至关重要。为此，本文对76例糖尿病患者进行尿微量白蛋白（Alb）测定，现将结果报告如下。     

尿内皮素在糖尿病患者肾脏微血管早期损害的诊断价值

目的探讨尿内皮素(ET)对糖尿病患者肾脏早期损害的诊断价值.方法选取常规尿蛋白阴性的2-型糖尿病患者68例,按微量蛋白排泄率(UAER)分为三组:DM1组(UAER＜30 mg/24 h);DM2组(UREA 30～300mg/24h);DM3组(UREA＞300mg/24 h).采用放射免疫检测法测定尿ET.结果糖尿病患者尿ET与对照组有显著差异(P＜0.01),且DM2组与DM1组有显著差异.尿α1微球蛋白与肌酐比(α1-MG/Cr),尿N-乙酰-β-D-氨基糖苷酶与肌酐比(NAG/Cr)与对照组有显著差异(P＜0.01),β2-MG/Cr除DM1组与对照组无显著差异外,其余两组均有显著差异.结论尿ET是诊断糖尿病早期肾脏微血管损害的敏感指标,对于糖尿病肾病的早期诊断、肾功能损害程度判断具有一定价值.     

尿视黄醇结合蛋白酶免疫测定法的建立和初步应用

我们自制兔（抗人ＲＢＰ）ＩｇＧ－ＨＲＰ酶标记物，建立了一种灵敏、简便、可靠的尿视黄醇结合蛋白（ＲＢＰ）双抗体夹心酶免疫测定法。方法灵敏度为０．４ｎｇ／ｍｌ；批内Ｃ．Ｖ．６．３％，批间Ｃ．Ｖ．１４．１％；工作范围０．４～５０ｎｇ／ｍｌ。本法的１００例正常健康人（２０～７４岁，平均４６岁）的尿ＲＢＰ值，以μｇ／ｍｍｏｌＣｒ表示，其算术均数（）±标准差（ｓ）为１１．２±６．０１；几何均数和９５％位点分别为９．５和２２。１０２例尿Ａ１ｂ正常的糖尿病患者，其尿ＲＢＰ值为４５．３±１０５．７μｇ／ｍｍｏｌＣｒ，较正常人明显增高（Ｐ＜０．００１），其中４０例（占３９．３％）高于正常上限。２５例肾功能正常的慢性肾盂肾炎中有２１例（占８４％）以及２４例其它各种肾小管间质疾病中的２２例（占９１．７％），尿ＲＢＰ值超越正常上限。肾小管损害可以是糖尿病肾病的一种早期症状。尿ＲＢＰ是近曲肾小管损害的一项敏感指标，对肾小管间质疾病的早期诊断具有重要价值。     

Renal tubular impairment in children with idiopathic hypercalciuria

Idiopathic hypercalciuria (IH) is defined as hypercalciuria that persists after correction of dietary inbalances and has no detectable cause. The excretion of urinary N-acetyl-beta-D-glucosaminidase (U-NAG), a marker of proximal tubular damage, has been previously reported as either increased or normal in children with IH. We evaluated U-NAG in 20 children (13 boys and 7 girls, mean age 10.3 years +/- 5.7 SD) with IH (urinary calcium excretion above 0.1 mmol/kg/24 hours, with no detectable cause) and with otherwise normal renal function tests. Ultrasound examination revealed urolithiasis (n=4) and nephrocalcinosis (n=1). The U-NAG values were evaluated in the spot urine collected from the second morning void and calculated as the urinary NAG/creatinine ratio (U-NAG/Cr) and expressed in nkat/mmol. The 24-hour urinary calcium excretion (U-Ca/24h) was assessed in a urinary sample from 24-hour collected urine and calculated in mmol/kg. The obtained results of U-Ca/24h and U-NAG/Cr were expressed as Z-scores. When compared to the reference data, the U-Ca/24h and U-NAG/Cr were significantly higher (p = 0.0004 and p = 0.006, respectively). There was no correlation between the U-NAG/Cr and U-Ca/24h (r = 0.18, p = 0.20). The U-NAG/Cr values were significantly higher in the 5 patients with urolithiasis/nephrocalcinosis, whether compared to the rest of the group (p = 0.02), or to the reference data (p = 0.01). The U-NAG/Cr activity was higher in 15 children without urolithiasis/nephrocalcinosis when compared to reference data (p < 0.01). There was no difference in U-Ca/24h between the children with and without urolithiasis/nephrocalcinosis (p = 0.58). These findings suggest that tubular impairment, as reflected by U-NAG/Cr, might occur in children with IH, especially in patients with urolithiasis/nephrocalcinosis. There doesn't seem to be a direct relationship between the U-NAG/Cr activity and the degree of calcium leakage.     

Secretion of immunoglobulins and plasma proteins from the colonic mucosa: an in vivo study in man.

There are no available data on immunoglobulins and albumin outputs into the normal human colon. We thus measured the intracolonic secretion rates of IgA, IgG, IgM, secretory component (SC) and plasma proteins (albumin (Alb), orosomucoid (Oro), transferrin (Transf) and alpha 2-macroglobulin (alpha 2-M)). Using a pancolonic perfusion technique in 10 healthy volunteers (six females, four males, mean age 24 years), concentrations and outputs of Alb, immunoglobulins, SC, Oro, Transf and alpha 2-M were measured in the rectal effluents by immunoradiometric assay. Monomeric (m) and polymeric (p) IgA distribution was analysed by sucrose density ultracentrifugation. The secretion of polymeric IgA (p-IgA) was 153 micrograms/min, i.e. 220 mg/day, exceeding that of other immunoglobulins (m-IgA 8.5 micrograms/min; IgG 33.5 micrograms/min; IgM 17 micrograms/min) and of non-immunoglobulin proteins (Alb 104 micrograms/min; Oro 9 micrograms/min; Transf 7 micrograms/min; alpha 2-M 4.5 micrograms/min). p-IgA was entirely linked to SC (secretory IgA) and 12% of SC was in free form. About 62% of total IgA was IgA2. For each protein, a relative coefficient of excretion (RCE) was calculated (colon to serum concentration ratio expressed relative to that of Alb). The p-IgA, IgM and m-IgA RCE were 277, 6 and 2.2 times higher than the values predicted from their molecular weight. RCE of non-immunoglobulin proteins also exceeded the values expected from a passive seepage from the vascular compartment. The intracolonic clearance of Alb extrapolated to 24 h was only 3.7 ml/day. These results show the high local production and/or the facilitated transport to the colonic lumen of p-IgA, and are in very good agreement with the distribution of plasma cells in the colonic mucosa.     

厄贝沙坦治疗2型糖尿病早期肾病的临床观察

目的：探讨厄贝沙坦对2型糖尿病早期肾病尿白蛋白、转铁蛋白的影响。方法：将36例入选患者随机分为三组,A组血压正常,仅用降糖药治疗;B组血压正常,降糖基础上给厄贝沙坦（75mg／d）;C组伴高血压,降糖基础上加厄贝沙坦,随访血压、24h尿白蛋白排泄量（24hUAlb）,24h尿转铁蛋白（24hUTRF）等。结果：3个月后,A组24hUAlb、24hUTRF及平均脉压（MAP）均无明显变化（P〉0．05）;B组24hUAlb、24hUTRF显著降低（P〈0．05）,MAP无显著变化（P〉0．05）;C组24hUAlb、24hUTRF及MAP均显著降低（P〈0．05）,且24hUAlb减少与MAP下降无相关性。结论：厄贝沙坦对2型糖尿病早期肾病有独立于降压作用之外的肾脏保护作用,且无明显副作用。     

胱抑素C和尿蛋白联合分析对早期糖尿病肾病的诊断价值研究

目的探讨糖尿病患者血清胱抑素C（CysC）、尿白蛋白（Alb）、β2微球蛋白（β2-M）、Tamm-Horsfall蛋白（T—HP）及视黄醇结合蛋白（RBP）的变化对早期糖尿病肾病的诊断价值。方法分别采用免疫比浊法和放射免疫法对糖尿病病人和正常人血清中的Cysc含量及尿中4项尿蛋白指标（Alb、β2-M、T—HP和RBP）的水平进行联合检测。结果糖尿病患者尿Alb、β2-M、RBP及血清CysC显著高于正常人（P〈0．01）,而尿T—HP则明显低于正常人（P〈0．01）,尿RBP水平与尿Alb含量呈显著正相关（r=＋0．47,P〈0．05）。随着肾脏病变的加重上述各项指标的异常改变更趋显著。结论联合检测糖尿病病人尿Alb、β2-M、T—HP、RBP及血清CysC有助于糖尿病肾病的早期诊断。     

Detection of a soluble form of the complement membrane attack complex inhibitor CD59 in plasma after acute myocardial infarction

Activation of the complement system has been documented in both experimental and clinical studies of acute myocardial infarction (AMI). Our earlier immunohistochemical studies have shown that the deposition of the membrane attack complex (MAC) of complement is associated with the loss of protectin (CD59), a glycosyl-phosphatidylinositol (GPI)-anchored sarcolemmal regulator of MAC, from the human and rat infarcted myocardium. In this study we detected, using an enzyme immunoassay (EIA), CD59 in the plasma of AMI patients at a concentration of 23.0+/-8.4 ng/ml (mean +/- SD; n = 17) at 4 h and 27.3+/-11.8 ng/ml (n = 24) at 24 h after AMI. Both values were significantly higher than in healthy controls (7.8+/-6.4 ng/ml; n = 20; P<0.001). The amount of CD59 correlated with the level of soluble terminal complement complexes (SC5b-9; r = 0.84; P<0.01) in the plasmas of AMI patients. Our results suggest that myocardial damage leads to release of CD59 from the sarcolemmal cell membranes during AMI.     

Fast double antibody radioimmunoassay of human granulocyte myeloperoxidase and its application to plasma.

The haem enzyme myeloperoxidase (MPO) (EC 1.11.1.7) with a spectral A430/A280 ratio greater than 0.7 and a specific activity of 125 U/mg was purified from isolated human neutrophils. To obtain a radioimmunoassay (RIA) for this enzyme, a specific antiserum against human neutrophil MPO was raised in rabbits and used at an initial dilution of 1/10,000. MPO labelled with 125iodine by a technique of self-labelling in the presence of H2O2, had a specific activity of 24 mCi/mg. After incubation at room temperature (2 h) and separation by double antibody precipitation in the presence of polyethylene glycol, the sensitivity of the RIA was 21 ng/ml. The RIA showed good precision and accuracy with intra- and interassay coefficients of variation of less than 7% for MPO concentrations ranging from 100 to 800 ng/ml, and satisfactory recoveries of known amounts of exogenous MPO in plasma. For the measurement of MPO in blood, the best sampling technique was to collect blood into EDTA. Rapid centrifugation (within 20 min) was necessary for blood collected into heparin. Mean MPO values in normal individuals were 340 +/- 98 ng/ml in EDTA plasma (n = 152) and 332 +/- 82 ng/ml in heparinized plasma (n = 34). When MPO was measured 12-6 h after injury in critically ill patients high values (above 1000 ng/ml) were found in 6/15 patients with multiple injuries. In patients with sepsis (n = 22), MPO values were always above 1000 ng/ml.     

尿白蛋白、视黄醇结合蛋白、转铁蛋白联合检测对糖尿病肾病早期诊断的意义

对４０例正常人测定２４小时尿白蛋白（Ａｌｂ）、视黄醇结合蛋白（ＲＢＰ）及转铁蛋白（ＴＲＦ），后两者９５％位数正常值为０．２２ｍｇ／２４ｈ、４．８８ｍｇ／２４ｈ。以上述三项指标共同测定４９例糖尿病患者２４ｈ尿，其中Ａｌｂ单项高于正常者２３例，占４６．９％，ＲＢＰ及ＴＲＦ单项高于正常者各２０例，各占４０．８％。若以三项联合检测中有一项异常即做为糖尿病肾病（ＤＮ）早期肾损伤，共有３１例，占６３．３％，其诊断ＤＮ阳性率明显高于单项异常者，Ｐ＜０．０５，且与合并糖尿病视网膜病变一致。可见，Ａｌｂ等糖尿病肾病早期诊断敏感指标的联合检测具有一定的临床意义。     

Polyamines in colorectal cancer--a clinical and experimental approach

The urinary polyamines putrescine, spermidine and spermine were measured prior to operation in 10 patients with colorectal cancer and 10 control subjects. Carcinoembryonic antigen assays were also performed in an attempt to correlate these values with polyamine excretion. The total polyamine rates in patients with colorectal cancer were 3.2 +/- 1.5 (SD) mg/24 h and 2.6 +/- 1.2 (SD) mg/24 h in the controls. The difference between the group with colorectal cancer and the controls was not statistically significant. Urinary polyamines were also measured in an experimental animal model for colorectal cancer in which tumour cell mass could be assessed. Only marginal differences occurred in polyamine rates between animals with extensive tumours and controls. These findings suggest that urinary polyamine measurement is unlikely to be a useful procedure to assess tumour cell mass in patients with colorectal cancer.     

Fast quantification of the urinary marker of oxidative stress 8-hydroxy-2'-deoxyguanosine using solid-phase extraction and high-performance liquid chromatography with triple-stage quadrupole mass detection

Exogenous and endogenous oxidants constantly cause oxidative damage to DNA. Since the reactive oxidants itself are not suitable for analysis, oxidized bases like 8-hydroxy-2'-deoxyguanosine (8OHdG) are used as biomarkers for oxidative stress, either in cellular DNA or as elimination product in urine. A simple, fast and robust analytical procedure is described for urinary 8OHdG as an indicator of oxidative damage in humans. The adduct was purified from human urine by applying a single solid-phase extraction step on LiChrolut EN. After evaporation of the eluate, the residue was resolved and an aliquote was injected into a HPLC system with a triple quadrupole mass spectrometer. The limit of detection was 0.2 ng ml(-1) (7 fmol absolute) when using one product ion as quantifier and two further product ions as qualifier. The coefficient of variation was 10.1% (n=5 at 2.8 ng ml(-1) urine). The sample throughput was about 50 samples a day. Thus, this method is more sensitive and much faster than the common method using HPLC with electrochemical detection. The results of a study with nine volunteers investigated at six time-points each over 5 days are presented. The mean excretion of 8OHdG was 2.1 ng mg(-1) creatinine (range 0.17-5.9 ng mg(-1) creatinine; 4 of 53 samples were below the LOD). A relatively large intra- (relative SD 66%) and inter-individual (relative SD 71%) variation in urinary 8OHdG excretion rates was found.