肾小管损伤因子在糖尿病高滤过患者中的水平变化

目的探讨肾小管损伤因子与2型糖尿病（T2DM）肾小球高滤过（GHF）的关系。方法以基于光抑素C（CysC）的Macisaac方程式估算肾小球滤过率（eGFR），筛选T2DM患者高滤过组30例及正常滤过组58例，并设健康对照组24例。常规方法测定肌酐、CysC、血糖、糖化血红蛋白等含量，EEISA及比浊法分别检测肾小管损伤因子NGAL、KIM-1、NAG等的水平。多因素分析各指标与高滤过组eGFR的相关性。结果高滤过组尿液NGAL、KIM-1水平均显著高于其他两组，而血浆NGAL含量却显著降低（均P〈0．05），尿液NAG水平在三组中差异无统计学意义。相关分析显示高滤过组eGFR与空腹血糖（r=0．250）、糖化血红蛋白（r=0．237）、尿液NGAL（r=0．388），KIM-1（r=-0．470）等成正相关，与血浆NGAL（r=-0．159）成负相关。结论尿液肾小管损伤因子在DM高滤过组的高水平表达，说明GHF可能直接导致肾小管早期损伤。

The change of the level of tubular markers in diabetes with glomerular hyper-filtration

Objective To explore the relationship between tubular markers and glomerular hyper- filtration（GHF） in type 2 diabetes mellitus（T2DM） patients. Methods Estimated glomerular filtration rate（eGFR） was calculated by Macisaac＇ s formulae based on cystatin C（CysC） levels. 30 cases of T2DM with GHF, 58 cases of T2DM with norm-GFR and 24 healthy people were recruited in the study. Creatinine, CysC, glucose and hemoglobin A1C were measured. Tubular markers NGAL, KIM-1 and NAG were determined by ELISA or colorimetric analysis. The correlation between these markers and eGFR were conducted by multivariate analysis in the GHF group. Results The GHF group had higher urinary NGAL, KIM-1 levels and lower serum NGAL level than those in other two groups（P 〈 0.05）. There was no statistical difference in the urinary NAG level among the three groups. Correlation analysis showed that eGFR was positively related to fasting blood glucose, HbAlc, urinary NGAL, and KIM-l（r=0.250, 0.237, 0.388, 0.470）, negatively related to serum NGAL（r=-0.159） in the GHF group. Conclusion The high levels of urinary tubular damage markers are found in T2DM patients with GHF, which may be a proof that GHF can directly result in early renal tubular damage.