不同尿白蛋白水平的糖尿病患者单核细胞趋化蛋白-1和尿N-乙酰β-D-氨基葡萄糖苷酶的含量变化及其临床意义

目的观察不同尿白蛋白水平的糖尿病患者单核细胞趋化蛋白1(MCP1)和尿N乙酰βD氨基葡萄糖苷酶(NAG)的含量变化及其临床意义。方法将60例糖尿病患者按尿白蛋白排泄率(UAER)的不同分为正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组3组。分别测定血清和尿MCP1的含量、尿NAG含量以及血肌酐(Scr)、糖化血红蛋白(GHbAlc),进行组间比较,并与对照组比较,同时做尿MCP1与GHbAlc、UAER、NAG的相关分析。结果尿MCP1含量及NAG含量在所有患者中均升高,明显高于对照组,且大量白蛋白尿组升高最明显,其升高程度与尿白蛋白排泄率增高程度一致,即随糖尿病肾病加重而逐渐升高。而血清MCP1水平较低,与对照组比较无显著性差异;尿MCP1与GHbAlc、UAER、NAG呈正相关关系。结论尿中MCP1升高与糖尿病肾病的发生发展有密切关系,尤其与肾小管间质损伤有更密切的关系。     

尿视黄醇结合蛋白、N-乙酰-β-D-氨基葡萄糖苷酶及尿蛋白检测在IgA肾病患者肾小管间质损害中的临床意义

目的 探讨尿视黄醇结合蛋白（RBP）、N-乙酰-β-D-氨基葡萄糖苷酶（NAG）及24小时尿蛋白定量（UPE）等指标判断IgA肾病（IgAN）患者肾小管间质损害程度的临床意义.方法 收集我院2010年5月～2013年2月114例住院IgAN患者的临床及病理资料,依据Lee氏病理分级系统将患者分为Lee I～Ⅱ级27例（A组）、LeeⅢ级46例（B组）和LeeⅣ～V级41例（C组）,分析不同分级IgAN肾小管间质病变情况与尿RBP、NAG、UPE等指标之间的相关性.结果 各组间血红蛋白（Hb）、白蛋白（ALB）、前白蛋白（pre-ALB）、血肌酐（SCr）、尿素氮（BUN）、总胆固醇（TC）、UPE、尿RBP及NAG等指标比较差异有统计学意义（P＜0.01）,镜下血尿及高血压的发生率随病理程度加重而上升（P＜0.01）,肾小管萎缩、肾间质炎细胞浸润、肾间质纤维化及动脉硬化在各组间比较差异均有统计学意义（P＜0.01）,相关性分析显示尿RBP、NAG与肾小管萎缩、肾间质炎症细胞浸润、肾间质纤维化及动脉硬化程度呈正相关;UPE与肾小管萎缩程度呈负相关（r=-0.213,P＜0.05）,尿RBP、NAG水平与eGFR呈负相关.结论 IgAN患者高血压及血尿发生率、Hb、ALB、TC、肾功能、RBP、NAG、UPE等指标与肾脏病理损伤程度有关,尿RBP、NAG及UPE联合检测对判断肾小管病理损伤程度及肾功能有临床意义.     

尿RBP和NAG与糖尿病肾病早期病变的关系

用酶联免疫法测定了80例2型糖尿病患者的尿RBP、NAG。结果：糖尿病患者尿RBP、NAG均较正常对照组增高。结论：在糖尿病早期阶段，肾小管功能会受到损害，尿RBP、NAG可作为诊断早期糖尿病肾病的敏感指标。     

2型糖尿病患者早期肾小球、肾小管功能的改变及其影响因素

目的 探讨2型糖尿病患者早期肾小球，肾小管功能的变化及其影响因素。方法 采用免疫散射比浊法测定了40例非临床糖尿病肾病的2型糖尿病患者尿微量白蛋白（mALb)，转铁蛋白（TRF），N－乙酰－β－D氨基葡萄糖苷酶（NAG），α1微球蛋白（α1－MG）含量，用多元回归分析糖尿病病程，患者年龄，血脂，血糖水平与各变量之间的关系。结果 2型糖尿病患者尿mALb,TRF,NAG,α1-MG排出增多，其升高的阳性率分别为22.5%,10%,30%,37.5% ；糖尿病病程的长短与mALb,TRF,α1-MG的排出正相关；血糖水平影响上述四种微量蛋白的排出；总胆固醇水平仅与mALb,TRF的增加有关。结论 糖尿病早期即存在肾小球，肾小管功能障碍，尽早控制糖尿病糖，脂代谢紊乱可改善肾脏的损害。     

尿RBP和NAG与糖尿病肾病早期病变的关系

用酶联免疫法测定了80例2型糖尿病患者的尿RBP、NAG.结果糖尿病患者尿RBP、NAG均较正常对照组增高.结论在糖尿病早期阶段,肾小管功能会受到损害,尿RBP、NAG可作为诊断早期糖尿病肾病的敏感指标.     

尿N⁃乙酰⁃β⁃D⁃氨基葡萄糖苷酶在2型糖尿病亚临床动脉粥样硬化中的变化及预测价值

目的 探讨尿N?乙酰?β?D?氨基葡萄糖苷酶(UNAG)在T2DM亚临床动脉粥样硬化(SAS)患者中的变化及预测价值.方法 选取2018年3月至2019年2月于玉林市第一人民医院内分泌科就诊的T2DM患者259例,根据颈动脉超声检测结果 分为SAS组149例和单纯T2DM组(T2DM)110例.收集临床资料并检测生化指...     

Effect of obstructive sleep apnea-hypopnea syndrome (OSAHS) on renal tubular function

目的 探讨睡眠呼吸暂停低通气综合征(OSAHS)对肾小管功能的影响.方法 选择OSAHS患者35例和对照组30例,检测受试者尿视黄醇蛋白(uRBP)、尿β2-微球蛋白(uβ2-MG)和尿N-乙酰-β-D-氨基葡萄糖苷酶酶(uNAG),同时检测OSAHS患者的最低血氧饱和度(LSa02)、血氧饱和度低于90％累积时间占睡眠时间(入睡到清晨觉醒前时间段)的百分比(DT90％)和睡眠呼吸紊乱指数(AHI),观察不同程度OSAHS对肾小管功能的影响.结果 (1)轻、中度OSAHS组患者uNAG、uβ2- MG和uRBP的水平与对照组比较差异无统计学意义(P＞0.05)；(2)重度OSAHS组患者的uNAG、uRBP、uβ2-MG水平明显高于对照组,也明显高于轻、中度组(P＜0.05).结论 重度OSAHS患者存在肾小管损伤,严重低氧血症可能是肾小管损伤的主要原因之一.     

尿N-乙酰-β-D-氨基葡萄糖苷酶在2型糖尿病亚临床动脉粥样硬化中的变化及预测价值

目的探讨尿N-乙酰-β-D-氨基葡萄糖苷酶(UNAG)在T2DM亚临床动脉粥样硬化(SAS)患者中的变化及预测价值。方法选取2018年3月至2019年2月于玉林市第一人民医院内分泌科就诊的T2DM患者259例,根据颈动脉超声检测结果分为SAS组149例和单纯T2DM组(T2DM)110例。收集临床资料并检测生化指标、UNAG及UACR。结果SAS组UNAG、UACR高于T2DM组[20.00(15.50,28.00)vs 7.50(5.00,12.05)U/L;7.81(4.39,14.46)vs 4.72(2.79,8.81)mg/g,P<0.05]。Spearman相关性分析显示,UANG与TC、LDL-C、FPG、2 h PG、HbA1c、UACR呈正相关(r=0.123、0.166、0.208、0.155、0.206、0.243,P<0.05);UACR与年龄、BMI、WC、SBP、DBP、UNAG呈正相关(r=0.186、0.153、0.184、0.207、0.151、0.288,P<0.05)。多因素Logistic回归分析显示,年龄、吸烟史、UNAG、UACR是SAS的影响因素。UNAG、UACR受试者工作特征曲线下面积为0.902、0.685,约登指数为0.691、0.314,敏感度为84.6%、70.5%,特异度为84.5%、60.9%。结论UNAG可能与T2DM患者SAS发生发展相关。UNAG预测T2DM合并SAS的切点为13.75 U/L。UNAG不受BP影响,相比UACR能更好地预测T2DM患者SAS。     

测定Ⅱ型糖尿病患者尿视黄醇结合蛋白的临床意义

对１３４例Ⅱ型糖尿病患者尿视黄醇结合蛋白、白蛋白、葡萄糖排泄及肌酐清除率（Ｃｃｒ）进行了检测，结果显示：①１３４例Ⅱ型糖尿病患者中，３９例（２９．１％）２４小时尿视黄醇结合蛋白（２４ｈｒＵＲＢＰ）排泄增加，其增高的发生率随尿白蛋白排泄增加而增加；正常、微量及大量白蛋白尿患者，其２４ｈｒＵＲＢＰ增高的发生率分别为１１．４％、４３．６％及７７．８％；②在微量及大量白蛋白尿患者中，２４ｈｒＵＲＢＰ增高者与２４ｈｒＵＲＢＰ正常者相比，Ｃｃｒ显著降低（Ｐ＜０．０５）。结果提示Ⅱ型糖尿病患者肾小管间质损害亦相当常见，并与肾功能减退有关。     

2型糖尿病患者肾小管标志蛋白检测的临床意义

目的 通过测定尿肾小管间质标志蛋白以探讨２型糖尿病患者肾小管间质病变。方法 同期测定２１５例２型糖尿病２４小时尿白蛋白（２４ｈＵＡＥ）,视黄醇结合蛋白（ＲＢＰ）、α１－微球蛋白、β２－微球蛋白（β２－ＭＧ）,Ｔａｍｍ－Ｈｏｒｓｆａｌｌ糖蛋白（ＴＨＰ）,尿糖（ＵＧ）和肌酐清除率（Ｃｃｒ）。     

以空腹血浆同型半胱氨酸水平评估2型糖尿病患者的肾小管功能

2型糖尿病患者中尿TammHorsfall蛋白排泄率降低者,空腹血浆同型半胱氨酸水平增高,提示肾小管合成功能障碍参与了糖尿病患者高同型半胱氨酸血症的发生。     

2型糖尿病患者尿白蛋白/肌酐比值与糖尿病视网膜病变关系的研究

目的 探讨2型糖尿病患者尿白蛋白/肌酐比值(UACR)与糖尿病视网膜病变(DR)的关系.方法 595例2型糖尿病患者进行UACR和眼底摄片检查,并根据UACR将患者分为3组:正常白蛋白尿组(n =519)、微量白蛋白尿组(n=28)和大量白蛋白尿组(n=48).比较3组患者的年龄、糖尿病病程等基本情况及DR发生率;同时以正常白蛋白尿组为参照,分析另外两组患者DR的相对危险度;最后,运用多元逐步线性回归和二元Logistic回归验证UACR与DR发生率的关系.结果 (1)3组患者的年龄、糖尿病病程、腰臀比、收缩压、舒张压、UACR差异有统计学意义(P＜0.05).(2)3组患者DR发生率依次升高,分别为30.4％、53.6％、54.2％,且差异有统计学意义(P＜0.001).(3)微量白蛋白尿组患DR的相对危险度为2.638 (95％ CI:1.225 ～ 5.682),大量白蛋白尿组患DR的相对危险度为2.702(95％ CI:1.486 ～4.902),且差异均存在统计学意义(P＜0.05).(4)多元逐步线性回归和二元Logistic回归显示,UACR与DR发生率有着显著的联系(P＜0.05).结论 2型糖尿病患者UACR与DR的发生密切相关.     

2型糖尿病伴肾脏病变患者肾活检指征探讨

目的 研究2型糖尿病(DM)伴肾脏病变怀疑合并非糖尿病肾病(NDN)患者肾活检的指征及临床特征.方法 对53例2型糖尿病患者[因①急性肾衰竭7例;②突出的肾小球源性血尿6例;③糖尿病病程＜5年而蛋白尿＞0.5 g/24h者29例;④糖尿病病程＞5年、大量蛋白尿而血压正常者(肾活检指征)11例]行肾活检、眼底和常规实验室检查.24例因其他原因肾活检、住院期间发现2型糖尿病的患者做对照.结果 糖尿病肾病(DN)占51%,非糖尿病肾病占49%,其中系膜增生性肾炎最多见占1/3.病程越长,糖尿病肾病发生率越高;伴有糖尿病眼部病变[糖尿病视网膜病、白内障、晶体或(和玻璃体)浑浊]者肾活检均为糖尿病肾病.非糖尿病肾病患者糖尿病眼部病变少,糖尿病肾病病程短.肾活检指征②非糖尿病肾病的检出率最高(83.3%),指征④最低(18.2%).结论 糖尿病眼部病变预测糖尿病肾病的特异性为100%;2型糖尿病合并非糖尿病肾病患者血尿突出,糖尿病病程短,糖尿病眼部病变少见.     

Circulating erythropoietin in microalbuminuric type 2 diabetic patients with normal renal function: a pilot study

To verify the hypothesis of an early impairment of erythropoietin (Epo) production and to assess the adequacy of its circulating levels in diabetic nephropathy, we investigated Epo values in 18 microalbuminuric type 2 diabetic patients with normal renal function (7 anaemic and 11 nonanaemic), 24 subjects with uncomplicated iron-deficiency anaemia, and 15 healthy controls comparable for sex and age. Mean±S.D. plasma Epo level was 56.4±12.7 mU/mL in iron-deficient patients and 9.3±2.6 mU/mL in controls. In diabetic groups, mean±S.D. Epo level was 11.38±3.65 mU/mL in nonanaemic and 49.12±6.44 mU/mL in anaemic subjects. No significant difference (P>.05) in Epo values was found between controls and nonanaemic diabetic patients. Anaemic diabetics and iron-deficient subjects had significantly higher values than the nonanaemic groups (P>.001). An inverse significant relation between Epo levels and Hb concentration resulted in both anaemic diabetics (r=−.44, P>.05) and iron-deficient patients (r=−.61, P=.001). Analysis of covariance (P>.05) and comparison of the two regression lines (t=0.4, df=29, P>.05) did not show any significant difference between diabetic patients with anaemia and iron-deficient patients. These results suggest that normochromic anaemia observed in microalbuminuric diabetic patients with normal renal function is not due to Epo deficiency, and circulating levels of this hormone are suitably increased with regard to Hb concentration.     

Normal urinary albumin excretion in recently diagnosed type 1 diabetic patients

The urinary excretion of albumin and retinol binding protein were measured in 51 recently diagnosed Type 1 diabetic patients and 48 control subjects, matched for age and sex. The diabetic patients, admitted consecutively to the Steno Memorial Hospital, were all studied 3 to 6 months after the onset of diabetes. Urinary albumin excretion (median and 95% confidence interval) was similar in the diabetic patients and normal control subjects (8 (6-11) vs 8 (6-11) mg 24-h-1, NS). Four diabetic patients had urinary albumin excretion in the microalbuminuric range of 30-300 mg 24-h-1. There was no significant difference between the two groups in urinary excretion of retinol binding protein. The distribution among the individuals of both urinary proteins was positively skewed and similar in the two groups. In conclusion, no significant differences in the urinary excretion of albumin and retinol binding protein were found between recently diagnosed Type 1 diabetic patients and normal subjects.     

2型糖尿病患者和一级亲属血浆胆囊收缩素的变化及意义

目的观察2型糖尿病患者(T2DM)及其一级亲属(FDRs)血浆胆囊收缩素(CCK)水平的变化并分析其相关因素。方法2003-062003-10将河北省人民医院的观察对象分为正常对照组(21例)、FDRs组(35例)、T2DM组(32例),检测受试者体重、空腹胰岛素、空腹血糖及血浆CCK水平变化,对比各组之间生化指标变化。以体重指数(BMI)=25kg/m~2为界限重新分组后进一步分析CCK与BMI的关系。结果血糖、BMI在对照组、FDRs组、T2DM组有逐渐升高趋势,但只在T2DM与对照组间差异有统计学意义(P<0·05)。CCK、胰岛素在对照组、FDRs组、T2DM组逐渐增高,且差异显著(均P<0·01)。以BMI为据分组后,FDRs组、T2DM组BMI>25kg/m~2的受试者胰岛素、CCK水平均明显高于同组BMI<25kg/m~2,血糖差异无显著性。结论T2DM及FDRs血浆CCK水平明显增高,其变化与胰岛素水平变化相似。肥胖可能与CCK、胰岛素水平变化有关。     

Lack of association between anemia and renal disease progression in Chinese patients with type 2 diabetes

Aims/Introduction

Anemia has a close interaction with renal dysfunction in diabetes patients. More proof is still awaited on the relationship between anemia and the progression of renal disease in this population.

Materials and Methods

In the present longitudinal study, 1,645 Chinese type 2 diabetes patients without end‐stage renal disease were included in the analysis in Nanjing, China, during January 2006 and December 2012. All patients were managed by staged diabetes management protocol, and clinical parameters were collected at each visit. The end‐point of progression of renal disease was evaluated during the follow up. Cox regression analysis was used to estimate the risk of anemia on renal disease progression.

Results

On recruitment, 350 (21.3%) patients had anemia, which was more common among those with older ages, longer diabetes duration, lower estimated glomerular filtration rate or more albuminura. On median follow up of 49 months (range 28–62 months), 37 patients (2.2%) developed the defined renal end‐point. Compared with those without anemia, patients with anemia had a higher risk of renal disease progression. However, multivariate analysis showed that anemia lost its statistical significance once estimated glomerular filtration rate was added into the model. Although the incidence of renal disease progression markedly increased by anemia status in patients of estimated glomerular filtration rate <60 mL/min/1.73 m², anemia was still not an independent risk factor for renal disease progression in this subgroup.

Conclusions

Anemia was a common finding in Chinese type 2 diabetes patients. Anemia was a risk factor for renal disease progression, but lost its significance once baseline renal function was adjusted.