發(fā)布時(shí)間：2018-09-06 14:42

【摘要】：目的:通過(guò)檢測(cè)Haptoglobin(HPt)及Periostin(PN)在2型糖尿病(type 2 diabetes mellitus,T2DM)及糖尿病腎病(diabetic kidney disease,DKD)患者尿液中的濃度并與尿白蛋白、尿N-乙酰-β-D-氨基葡萄糖苷酶(urinary N-and acetyl beta-D-Glucosaminidase,UNAG)、尿α1-微球蛋白(α1-microglobulin,α1-MG)、血清胱抑素C(cystatin C,Cys-C)、腎小球?yàn)V過(guò)率(eGFR)等相關(guān)腎臟損傷指標(biāo)進(jìn)行比較分析,探討尿HPt及PN與T2DM患者腎臟損害的相關(guān)性。方法:選取于我院內(nèi)分泌科就診的T2DM患者119例,根據(jù)尿白蛋白/肌酐(UACR)比值分為正常白蛋白尿組(NAU組,n=36)、微量白蛋白尿組(MAU組,n=53)及大量白蛋白尿組(CDN組,n=30),同時(shí)選取同期健康體檢者31例作為對(duì)照組(NC組)。運(yùn)用酶聯(lián)免疫吸附法檢測(cè)受試者尿液HPt及PN濃度,所有結(jié)果經(jīng)尿肌酐(creatinine,Cr)校正。結(jié)果:1.尿HPt/Cr和尿PN/Cr水平在T2DM各組與NC組比較均顯著升高,且尿HPt/Cr在T2DM各組中隨UACR水平升高而升高,即NAU組MAU組CDN組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);尿PN/Cr水平在T2DM各組中雖然隨UACR水平升高而升高,但各組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.Cys-C、尿α1-MG/Cr、UNAG/Cr在T2MD各組均顯著高于NC組,且Cys-C、UNAG/Cr在T2MD各組中隨UACR升高而遞增,即NAU組MAU組CDN組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);尿α1-MG/Cr在MAU組、CDN組顯著高于NAU組(P0.05)。eGFR在CDN組顯著降低于其余各組(P0.05)。3.Spearman相關(guān)分析顯示,尿HPt/Cr與Cys-C、UACR、尿α1-MG/Cr、UNAG/Cr、尿PN/Cr呈正相關(guān),與eGFR呈負(fù)相關(guān)(P0.05);尿PN/Cr與UACR、尿α1-MG/Cr、UNAG/Cr呈正相關(guān),與eGFR呈負(fù)相關(guān)(P0.05),與Cys-C無(wú)明顯相關(guān)(P=0.05)。4.以UACR=30μg/mg為分界值作ROC曲線,尿HPt/Cr曲線下面積為0.804,尿PN/Cr曲線下面積為0.665,可見(jiàn)尿HPt/Cr曲線下面積大于尿PN/Cr曲線下面積。結(jié)論:1.尿HPt和尿PN都與T2MD患者腎臟損害有關(guān),二者可能是2型糖尿病腎病的生物標(biāo)志物,但尿PN對(duì)T2MD患者腎臟損害病情變化的敏感性還需要進(jìn)一步的研究。2.尿HPt對(duì)T2MD患者腎臟損害的嚴(yán)重程度判斷以及病情監(jiān)測(cè)具有十分重要的意義。3.尿HPt對(duì)早期DKD的診斷價(jià)值優(yōu)于尿PN,尿液取材方便、無(wú)創(chuàng)傷、無(wú)副作用、可反復(fù)操作,因而尿HPt可能成為診斷早期DKD及監(jiān)測(cè)DKD進(jìn)展的理想生物標(biāo)志物。
[Abstract]:Objective: to detect the concentrations of Haptoglobin (HPt) and Periostin (PN) in urine of patients with type 2 diabetes mellitus (type 2 diabetes mellitus,T2DM) and diabetic nephropathy (diabetic kidney disease,DKD). Urinary N- acetyl- 尾 -D- glucosaminidase (urinary N-and acetyl beta-D-Glucosaminidase,UNAG), urine 偽 1-microglobulin (偽 1-MG), serum cystatin (C (cystatin C), glomerular filtration rate (eGFR) were compared and analyzed to explore the correlation between urinary HPt and PN and renal damage in T2DM patients. Methods: 119 patients with T2DM were selected from Endocrinology Department in our hospital. According to the ratio of urinary albumin / creatinine (UACR), it was divided into normal albuminuria group (NAU group), microalbuminuria group (MAU group) and large albuminuria group (CDN group). 31 healthy volunteers were selected as control group (NC group). Urine HPt and PN concentrations were measured by enzyme linked immunosorbent assay (Elisa). All the results were corrected by urinary creatinine (creatinine,Cr). The result is 1: 1. The levels of urinary HPt/Cr and urinary PN/Cr in T2DM group were significantly higher than those in NC group, and the level of urinary HPt/Cr in T2DM group increased with the increase of UACR level, that is, NAU group MAU group CDN group. The urinary PN/Cr level in T2DM group increased with the increase of UACR level, but there was no significant difference among the three groups (P0.05). 2. Cys-C. urine 偽 1-MG / Cr UNAG / Cr level in T2MD group was significantly higher than that in NC group, and Cys-C,UNAG/Cr increased with UACR in T2MD group. There was significant difference between CDN group and MAU group in NAU group (P0.05), urinary 偽 1-MG/Cr in MAU group was significantly higher than that in NAU group (P0.05) .eGFR in CDN group was significantly lower than that in other groups (P0.05). 3. Spearman correlation analysis showed that there was a positive correlation between urinary HPt/Cr and Cys-C,UACR, urine 偽 1-MGp-CrUNAGCr-Cr, urine PN/Cr. There was a negative correlation between urinary PN/Cr and UACR, 偽 1-MG / CrUNAG / Cr, a negative correlation with eGFR (P0.05), and no significant correlation with Cys-C (P0. 05). 4. With UACR=30 渭 g/mg as the boundary value, the area under the HPt/Cr curve was 0.804, and the area under the PN/Cr curve was 0.665. The area under the HPt/Cr curve was larger than that under the PN/Cr curve. Conclusion 1. Both urinary HPt and urinary PN are associated with renal damage in T2MD patients. Both may be biomarkers of type 2 diabetic nephropathy, but the sensitivity of urinary PN to renal damage in T2MD patients needs further study. Urinary HPt is of great significance in judging the severity and monitoring of renal damage in patients with T2MD. The diagnostic value of urine HPt for early DKD is better than that for urine PN,. Urine HPt may be an ideal biomarker for diagnosing early DKD and monitoring the progression of DKD.
【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2;R692.9

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