Asami T, Nakano T, Sakai K
Department of Pediatrics, School of Medicine, Niigata University.
Nihon Jinzo Gakkai Shi. 1992 Jan;34(1):57-63.
To study the relations between renal tubular disorder and glomerular dysfunction in the early phase of insulin-dependent diabetes mellitus (IDDM), we performed concomitant measurements of urinary beta-D-N-acetyl glucosaminidase (NAG), beta 2-microglobulin (BMG), and microalbumin in 29 of pediatric patients with IDDM, 15 normal controls, and 83 patients with non-diabetic ketoacidosis. Urinary NAG levels were significantly elevated in the IDDM patients compared with controls. Urinary BMG levels were also elevated in IDDM, however, they were not as prominent as NAG levels. Although urinary microalbumin levels were elevated in the IDDM patients, statistical analysis did not show any significant difference between the IDDM patients and controls. Urinary NAG and BMG concentrations were also increased in patients with non-diabetic ketoacidosis, suggesting a toxic effect of ketone bodies to renal tubular cells. Statistically significant correlations were noted both between urinary NAG and microalbumin and between urinary BMG and microalbumin. These results suggest that, in early phase of IDDM, microalbuminuria is preceded by elevations in urinary NAG and BMG levels, and that keton bodies have deleterious effects on renal tubular cells.
为研究胰岛素依赖型糖尿病（IDDM）早期肾小管功能障碍与肾小球功能异常之间的关系，我们对29例儿童IDDM患者、15例正常对照者以及83例非糖尿病酮症酸中毒患者同时进行了尿β-D-N-乙酰氨基葡萄糖苷酶（NAG）、β2-微球蛋白（BMG）和微量白蛋白的检测。与对照组相比，IDDM患者的尿NAG水平显著升高。IDDM患者的尿BMG水平也升高，然而，其升高程度不如NAG水平显著。虽然IDDM患者的尿微量白蛋白水平升高，但统计学分析显示IDDM患者与对照组之间无显著差异。非糖尿病酮症酸中毒患者的尿NAG和BMG浓度也升高，提示酮体对肾小管细胞有毒性作用。尿NAG与微量白蛋白之间以及尿BMG与微量白蛋白之间均存在显著的统计学相关性。这些结果表明，在IDDM早期，微量白蛋白尿之前尿NAG和BMG水平会升高，并且酮体对肾小管细胞有有害影响。
