尿中性粒细胞明胶酶相关脂质运载蛋白/肌酐比值在2型糖尿病肾损伤的早期诊断及病情评估中的临床应用

doi:10.16150/j.1671-2870.2019.01.012

诊断学理论与实践 ›› 2019, Vol. 18 ›› Issue (1): 61-65.doi: 10.16150/j.1671-2870.2019.01.012

尿中性粒细胞明胶酶相关脂质运载蛋白/肌酐比值在2型糖尿病肾损伤的早期诊断及病情评估中的临床应用

邓琳¹(), 丁怡², 汪萍¹, 卞炳贤¹, 沈立松¹

1. 上海交通大学医学院附属新华医院检验科，上海 200092
2. 上海市养志康复医院（上海市阳光康复中心）神经康复科，上海 201619

收稿日期:2018-12-19 出版日期:2019-02-25 发布日期:2019-02-25
通讯作者: 邓琳 E-mail:denglin@xinhuamed.com.cn
基金资助:
上海市卫生局课题(20154Y0095);上海市市科委课题(15D1940805)

Application of urinary neutrophil gelatinase-associated lipocalin/creatinine ratio in early diagnosis and severity assessment of renal injury in patients with type 2 diabetes mellitus

DENG Lin¹(), DING Yi², WANG Ping¹, BIAN Bingxian¹, SHEN Lisong¹

1. Department of Clinical Laborartory，Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
2. Department of Neurological Rehabilitation，Shanghai Yangzhi Rehabilitation Hospital(Shanghai Sunshine Rehabilitation Center)，Shanghai 201619, China

Received:2018-12-19 Online:2019-02-25 Published:2019-02-25
Contact: DENG Lin E-mail:denglin@xinhuamed.com.cn

摘要/Abstract

摘要：

目的：探讨尿中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase-associated lipocalin,NGAL）/肌酐比值在2型糖尿病患者肾脏损伤的早期诊断及病情评估中的临床应用价值。方法：纳入2型糖尿病患者112例，根据尿白蛋白/肌酐比值（urinary albumin/creatinine ratio，UACR）将患者分为尿白蛋白正常（normo-albuminuria, NA）组（38例）、微量白蛋白尿（micro-albuminuria, MA）组（36例）及临床白蛋白尿（clinical albuminuria, CA）组（38例），并以同期32例健康体检者作为正常对照。采用化学发光微粒子免疫检测法测定各组的尿NGAL浓度，并计算尿NGAL/肌酐比值。比较正常对照组及2型糖尿病各组的尿NGAL水平，并与其他临床指标作相关性分析。结果：2型糖尿病各组的尿NGAL/肌酐比值均明显高于正常对照组[正常对照组，9.13(3.92~17.36) ng/mg;NA组，16.46(6.94~27.07) ng/mg;MA组，20.16(6.76~44.35) ng/mg;CA组，26.89(10.60~56.94) ng/mg]（P<0.05），而在2型糖尿病各组间，CA组、MA组的NGAL/肌酐比值明显高于NA组（P<0.05）。相关性分析显示，尿NGAL/肌酐比值与UACR、糖尿病病程、糖化血红蛋白（glycated hemoglobin, HbA1c）呈正相关（P<0.05）。结论：与尿微量白蛋白相比，尿NGAL/肌酐比值可能较更早提示2型糖尿病患者的肾脏损伤，并可在一定程度上评估其疾病严重程度。

Abstract:

Objective: To investigate the application of urinary neutrophil gelatinase associated lipocalin (NGAL)/creatinineratio in the early diagnosis and assessment of severity of renal injury in patients with type 2 diabetes mellitus (T2DM). Methods: A group of 112 T2DM patients were recruited. Based on urinary albumin/creatinine ratio (UACR), diabetic patients were divided into three groups: 38 cases with normal albuminuria (NA group), 36 cases with minimal albuminuria (MA group) and 38 cases with clinical albuminuria (CA group). And, 32 healthy subjects were served as controls (NC group). Urinary NGAL/creatinine ratio was calculated and compared among the groups and their correlations with other clinical parameters were analyzed. Results: Urinary NGAL/creatinine ratio in T2DM groups [NA, 16.46(6.94-27.07) ng/mg;MA, 20.16(6.76-44.35) ng/mg;CA, 26.89(10.60-56.94) ng/mg] was markedly increased than that in the normal control group [9.13(3.92-17.36) ng/mg] (P<0.05). In the T2DM groups, urinary NGAL/creatinine ratio in CA group was significantly higher than that in NA group (P<0.05). Correlation analysis showed that urinary NGAL/creatinine ratio was positively correlated with UACR, duration of diabetes and glycated hemoglobin (HbA1c) (P<0.05). Conclusions: Urinary NGAL could be an earlier marker than minimal albuminuria for detecting renal injury in T2DM. Furthermore, urinary NGAL level can evaluate the severity of renal injury.

Key words: Urinary neutrophil gelatinase-associated lipocalin, Urinary neutrophil gelatinase-associated lipocalin/creatinine ratio, Type 2 diabetic nephropathy

中图分类号:

R587.1

邓琳, 丁怡, 汪萍, 卞炳贤, 沈立松. 尿中性粒细胞明胶酶相关脂质运载蛋白/肌酐比值在2型糖尿病肾损伤的早期诊断及病情评估中的临床应用[J]. 诊断学理论与实践, 2019, 18(1): 61-65.

DENG Lin, DING Yi, WANG Ping, BIAN Bingxian, SHEN Lisong. Application of urinary neutrophil gelatinase-associated lipocalin/creatinine ratio in early diagnosis and severity assessment of renal injury in patients with type 2 diabetes mellitus[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(1): 61-65.

图/表 4

表1

图1

表2

表3

参考文献 15

[1]	Huang YM, Xu D, Long J, et al. The spectrum of chronic kidney disease in China: a national study based on hospitalized patients from 2010 to 2015[J/OL]. Nephrology (Carlton), 2018-08-09[2018-12-19].https://www.ncbi.nlm.nih.gov/pubmed/30198082.
[2]	Tuttle KR, Bakris GL, Bilous RW, et al. Diabetic kidney disease: a report from an ADA Consensus Conference[J]. Diabetes Care, 2014, 37(10):2864-2683.
[3]	中华医学会糖尿病学分会微血管并发症学组. 糖尿病肾病防治专家共识(2014年版)[J]. 中华糖尿病杂志, 2014, 6(11):792-801.
[4]	张春雷, 曾学辉, 李忠新, 等. 尿KIM-1和NGAL在糖尿病肾病早期诊断中的应用[J]. 现代检验医学杂志, 2015, 30(1):52-54.
[5]	Retnakaran R, Cull CA, Thorne KI, et al. Risk factors for renal dysfunction in type 2 diabetes: U.K. Prospective Diabetes Study 74[J]. Diabetes, 2006, 55(6):1832-1839.
[6]	Satirapoj B. Tubulointerstitial Biomarkers for Diabetic Nephropathy[J]. J Diabetes Res, 2018, 2018:2852398.
[7]	Yaqoob M, McClelland P, Patrick AW, et al. Evidence of oxidant injury and tubular damage in early diabetic nephropathy[J]. QJM, 1994, 87(10):601-607.
[8]	Buonafine M, Martinez-Martinez E, Jaisser F. More than a simple biomarker: the role of NGAL in cardiovascular and renal diseases[J]. Clin Sci (Lond), 2018, 132(9):909-923.
[9]	Lippi G, Cervellin G. Neutrophil gelatinase-associated lipocalin: a more specific assay is needed for diagnosing renal injury[J]. Clin Chim Acta, 2012, 413(13-14):1160-1161.
[10]	Shang W, Wang Z. The Update of NGAL in Acute Kidney Injury[J]. Curr Protein Pept Sci, 2017, 18(12):1211-1217.
[11]	Wu J, Shao X, Lu K, et al. Urinary RBP and NGAL Leve-ls are Associated with Nephropathy in Patients with Type 2 Diabetes[J]. Cell Physiol Biochem, 2017, 42(2):594-602.
[12]	Wu J, Ding Y, Zhu C, et al. Urinary TNF-α and NGAL are correlated with the progression of nephropathy in patients with type 2 diabetes[J]. Exp Ther Med, 2013, 6(6):1482-1488.
[13]	Bolignano D, Lacquaniti A, Coppolino G, et al. Neutrophil gelatinase-associated lipocalin as an early biomarker of nephropathy in diabetic patients[J]. Kidney Blood Press Res, 2009, 32(2):91-98.
[14]	Yang YH, He XJ, Chen SR, et al. Changes of serum and urine neutrophil gelatinase-associated lipocalin in type-2 diabetic patients with nephropathy: one year observatio-nal follow-up study[J]. Endocrine, 2009, 36(1):45-51.
[15]	Fu WJ, Xiong SL, Fang YG, et al. Urinary tubular biomarkers in short-term type 2 diabetes mellitus patients: a cross-sectional study[J]. Endocrine, 2012, 41(1):82-88.

项目	正常对照组（n=32）	2型糖尿病组			P值
项目	正常对照组（n=32）	NA组（n=38）	MA组（n=36）	CA组（n=38）	P值
性别 (男/女)	16/16	22/16	20/16	24/14	0.736
年龄 (岁)	54.47±6.66	55.39±8.86	58.36±7.77	57.97±9.41	0.140
高血压史（%）	0	23.72^a)	52.86^a),b)	71.13^a),b)	<0.001
冠心病史（%）	0	0	0	21.12^a),b),c)	<0.001
吸烟史（%）	21.92	26.34	27.82	28.91	0.919
体质量指数 (kg/m²)	24.15±2.74	24.17±3.69	25.35±3.72	26.50±3.58^a),b)	0.012
病程(年)	-	6.60±6.04^a)	10.34±7.07^a),b)	10.59±7.93^a),b)	<0.001
空腹血糖 (mmol/L)	5.26±0.38	7.93±3.05^a)	7.92±3.01^a)	8.38±3.08^a)	<0.001
HbA1c (%)	5.54±0.23	8.03±1.57^a)	8.80±1.81^a),b)	8.77±2.04^a),b)	<0.001
血肌酐 (μmol/L)	62.13±12.34	54.00±10.00^a)	54.58±13.73^a)	78.37±29.70^a),b),c)	<0.001
尿酸 (μmol/L)	267.25±74.29	300.55±104.54	306.61±83.15	356.16±82.23^a),b),c)	0.001
eGFR[mL/(min·1.73 m²)]	103.74±9.63	108.40±9.68	105.73±10.27	88.15±24.95^a),b),c)	<0.001
UACR(mg/g)	5.84(4.85~8.73)	12.69(8.69~20.81)	98.03(66.67~166.96)^a),b)	648.86(383.62~1765.89)^a),b),c)	<0.001

指标	正常对照组 (n=32)	2型糖尿病组			P值
指标	正常对照组 (n=32)	NA组(n=38)	MA组(n=36)	CA组(n=38)	P值
尿NGAL/肌酐比值 (ng/mg)	9.13(3.92~17.36)	16.46(6.94~27.07)^a)	20.16(6.76~44.35)^a)	26.89(10.60~56.94)^a),b)	0.001

指标	相关系数r值	P值
UACR	0.355	<0.001
体质量指数	-0.094	0.261
收缩压	0.111	0.184
病程	0.259	0.002
空腹血糖	0.148	0.077
HbA1c	0.305	<0.001
血肌酐	-0.119	0.156
尿素氮	-0.030	0.717
尿酸	-0.048	0.569
eGFR	-0.134	0.109

尿中性粒细胞明胶酶相关脂质运载蛋白/肌酐比值在2型糖尿病肾损伤的早期诊断及病情评估中的临床应用

Application of urinary neutrophil gelatinase-associated lipocalin/creatinine ratio in early diagnosis and severity assessment of renal injury in patients with type 2 diabetes mellitus

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 15

相关文章 1

编辑推荐

Metrics

本文评价