Torffvit O, Agardh C D, Kjellsson B, Wieslander J
Department of Nephrology, University Hospital, Lund, Sweden.
Clin Chim Acta. 1992 Jan 31;205(1-2):31-41. doi: 10.1016/0009-8981(92)90351-p.
The relationship between glomerular and tubular dysfunction and metabolic control in type 1 diabetes was studied. To that end the urinary excretion rates of albumin and Tamm-Horsfall protein as well as HbA1c levels were measured in 58 patients with different degrees of diabetic nephropathy and in 76 apparently healthy subjects matched for sex and age. The urinary Tamm-Horsfall protein levels were measured by a simplified enzyme linked immunoassay. The intra- and interassay variations were 8.9% and 13.6%, respectively. The intraindividual variation was 41% and the sensitivity of the assay was 4 micrograms/l. The Tamm-Horsfall protein excretion rate was 42.1 x/2.0 micrograms/min (geometric mean x/tolerance factor) in the diabetic patients compared to 34 x/1.9 micrograms/min in the control subjects (NS). The diabetic patients had higher albumin excretion rate (38.5 x/7.3 micrograms/min) than the control subjects (4.7 x/2.3 micrograms/min; P less than 0.001). By using multivariate analysis of variance, HbA1c level was found to be the only independent variable associated with Tamm-Horsfall protein excretion rate in diabetic patients (r = -0.28; P = 0.04), while no relationship was found between Tamm-Horsfall protein excretion rate and age, age at onset and duration of diabetes, gender, serum creatinine, diuresis, urinary albumin excretion rate, systolic and diastolic blood pressure levels and antihypertensive treatment. The urinary albumin excretion rate was associated with diastolic blood pressure (r = 0.34; P = 0.02) but not with HbA1c levels when testing the above variables by multivariate analysis of variance. In conclusion, these results may indicate a lack of relationship between glomerular and tubular dysfunction. The former was influenced only by diastolic blood pressure levels and the latter only by the degree of metabolic control. However, the correlations were weak and do not provide any insight into what is actually responsible for glomerular and tubular dysfunction.
研究了1型糖尿病患者肾小球和肾小管功能障碍与代谢控制之间的关系。为此，对58例不同程度糖尿病肾病患者以及76例年龄和性别匹配的健康受试者测量了白蛋白和Tamm-Horsfall蛋白的尿排泄率以及糖化血红蛋白（HbA1c）水平。采用简化的酶联免疫分析法测定尿Tamm-Horsfall蛋白水平。批内变异和批间变异分别为8.9%和13.6%。个体内变异为41%，该检测方法的灵敏度为4微克/升。糖尿病患者的Tamm-Horsfall蛋白排泄率为42.1×/2.0微克/分钟（几何平均数×耐受因子），而对照组为34×/1.9微克/分钟（无显著性差异）。糖尿病患者的白蛋白排泄率（38.5×/7.3微克/分钟）高于对照组（4.7×/2.3微克/分钟；P<0.001）。通过多变量方差分析发现，HbA1c水平是与糖尿病患者Tamm-Horsfall蛋白排泄率相关的唯一独立变量（r = -0.28；P = 0.04），而Tamm-Horsfall蛋白排泄率与年龄、发病年龄、糖尿病病程、性别、血清肌酐、尿量、尿白蛋白排泄率、收缩压和舒张压水平以及抗高血压治疗之间均无相关性。在通过多变量方差分析检测上述变量时，尿白蛋白排泄率与舒张压相关（r = 0.34；P = 0.02），但与HbA1c水平无关。总之，这些结果可能表明肾小球和肾小管功能障碍之间缺乏相关性。前者仅受舒张压水平影响，后者仅受代谢控制程度影响。然而，这些相关性较弱，无法深入了解导致肾小球和肾小管功能障碍的实际原因。
