1 型糖尿病年轻患者尿型 IV 胶原与 GFR 下降的关系。

Association of urinary type IV collagen with GFR decline in young patients with type 1 diabetes.

机构信息

Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.

出版信息

Am J Kidney Dis. 2011 Dec;58(6):915-20. doi: 10.1053/j.ajkd.2011.04.019. Epub 2011 Jul 16.

DOI:10.1053/j.ajkd.2011.04.019

PMID:21763044

Abstract

BACKGROUND

Some patients with diabetes have advanced diabetic glomerular lesions and progressive kidney function decline even if urinary albumin levels are in the normal range. Therefore, another prognostic marker for diabetic kidney disease needs to be identified. We aimed to clarify whether urinary type IV collagen is associated with the progression of kidney function decline in patients with type 1 diabetes.

STUDY DESIGN

Hospital-based observational cohort study.

SETTING & PARTICIPANTS: 231 normo- and microalbuminuric patients with type 1 diabetes who were younger than 40 years at the start of the study. PREDICTOR & MEASUREMENTS: Urinary type IV collagen, determined using a 1-step sandwich enzyme immunoassay.

OUTCOME

The primary outcome measurement was rate of change in estimated glomerular filtration rate (eGFR).

RESULTS

Mean follow-up was 7.4 ± 1.3 (standard deviation) years. Urinary type IV collagen-creatinine ratio (T4C) was associated significantly with rate of change in eGFR in both univariate (r = -0.169; P = 0.01) and multivariate regression analyses (standardized estimate = -0.131; P = 0.03). In the sensitivity analysis limited to patients with normoalbuminuria (n = 213), T4C, but not urinary albumin-creatinine ratio (ACR), was associated significantly with rate of change in eGFR (standardized estimate = -0.12; P = 0.03). The interaction between logarithmically transformed ACR and logarithmically transformed T4C on eGFR decline was not significant (P for interaction = 0.2). We compared the adjusted rate of change in eGFR among 4 groups classified according to normal or increased T4C and ACR values and found that the rate of decline in eGFR in patients with increased T4C and normal ACR values was significantly faster than that in patients with normal T4C and ACR values (-4.3 and -3.0 mL/min/1.73 m(2)/y; P = 0.004, analysis of covariance).

LIMITATIONS

Study size was relatively small.

CONCLUSIONS

T4C is associated with progression of kidney function decline in young patients with type 1 diabetes.

摘要

背景

有些糖尿病患者尽管尿白蛋白水平正常，但已出现晚期糖尿病肾小球病变和进行性肾功能下降。因此，需要寻找另一种预测糖尿病肾病的标志物。本研究旨在明确尿Ⅳ型胶原是否与 1 型糖尿病患者肾功能下降的进展有关。

设计

医院观察性队列研究。

地点和参与者

231 例初诊时年龄＜40 岁的 1 型糖尿病患者，且尿白蛋白处于正常或微量范围。

预测指标和测量方法

采用一步夹心酶免疫分析法检测尿Ⅳ型胶原。

主要转归指标

肾小球滤过率估计值（eGFR）的变化率。

结果

平均随访 7.4±1.3 年。在单变量（r=-0.169，P=0.01）和多变量回归分析中（标准化估计值=-0.131，P=0.03），尿Ⅳ型胶原与肌酐比值（T4C）均与 eGFR 的变化率显著相关。在仅限于尿白蛋白正常患者的敏感性分析中（n=213），T4C 而非尿白蛋白/肌酐比值（ACR）与 eGFR 的变化率显著相关（标准化估计值=-0.12，P=0.03）。ACR 和 T4C 的对数值在 eGFR 下降方面的交互作用无统计学意义（P 交互=0.2）。我们比较了根据 T4C 和 ACR 值的正常或升高分为 4 组的患者的 eGFR 调整后变化率，发现 T4C 升高和 ACR 值正常患者的 eGFR 下降速度明显快于 T4C 正常和 ACR 值正常患者（-4.3 和-3.0 mL/min/1.73 m2/y；P=0.004，协方差分析）。