管状标记物与蛋白尿 2 型糖尿病患者肾功能下降有关。
Tubular markers are associated with decline in kidney function in proteinuric type 2 diabetic patients.
机构信息
Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark.
出版信息
Diabetes Res Clin Pract. 2012 Jul;97(1):71-6. doi: 10.1016/j.diabres.2012.02.007. Epub 2012 Mar 7.
UNLABELLED
Our aim was to investigate u-NGAL, u-KIM1 and p-FGF23 and prediction of decline in kidney function in type 2 diabetic patients with proteinuria.
METHODS
We performed a follow-up study, follow-up median (range) 3.5 (1-5) years. At baseline u-NGAL, u-KIM1 and p-FGF23 (ELISA) was measured and patients were followed yearly with estimated(e)-GFR (MDRD) and u-albumin.
RESULTS
We included 177 patients (44 women), mean age (SD) 59 (9) years. eGFR 90 (24) ml/min/1.73 m(2) at baseline, u-albumin: median (interquartile range) 104 (39-238) mg/24 h. Patients with levels of u-KIM1 in the highest quartile had a greater decline in eGFR than patients with the lowest quartile 6.0 (5.4) versus 3.2 (5.5) ml/min/1.73 m(2) per year (p=0.02). u-NGAL in the highest versus lowest quartile eGFR decline: 5.1 (4.7) and 2.8 (7.1)ml/min/1.73 m(2) per year (p=0.07). Higher values of u-NGAL and u-KIM1 were associated with enhanced decline in eGFR (R=0.16 and R=0.19, p<0.05), however not after adjustment for progression promoters. p-FGF23 was not predictive of decline in eGFR.
CONCLUSION
Higher levels of markers of tubular damage are associated with a faster decline in eGFR. However, since this is not independent of known progression promoters, measurement of tubular markers does not give additional prognostic information.
目的
本研究旨在探讨尿中性粒细胞明胶酶相关脂质运载蛋白（u-NGAL）、尿肾损伤分子-1（u-KIM1）和血成纤维细胞生长因子 23（p-FGF23）与合并蛋白尿的 2 型糖尿病患者肾功能下降的关系。
方法
我们进行了一项随访研究，中位随访时间（范围）为 3.5（1-5）年。基线时检测 u-NGAL、u-KIM1 和 p-FGF23（ELISA 法），每年随访 1 次，检测估算的肾小球滤过率（eGFR）（MDRD 公式）和尿白蛋白。
结果
共纳入 177 例患者（44 例女性），年龄（标准差）为 59（9）岁。基线时 eGFR 为 90（24）ml/min/1.73m2，尿白蛋白中位数（四分位数间距）为 104（39-238）mg/24 h。u-KIM1 水平最高四分位数组患者的 eGFR 下降速度快于最低四分位数组患者（6.0[5.4]比 3.2[5.5]ml/min/1.73m2/年，p=0.02）。u-NGAL 水平最高四分位数组与最低四分位数组患者的 eGFR 下降速度分别为 5.1（4.7）和 2.8（7.1）ml/min/1.73m2/年（p=0.07）。较高的 u-NGAL 和 u-KIM1 水平与 eGFR 下降速度加快相关（R=0.16 和 R=0.19，p<0.05），但在校正了已知的进展促进剂后，相关性消失。p-FGF23 不能预测 eGFR 的下降。
结论
肾小管损伤标志物水平升高与 eGFR 下降速度加快相关。然而，由于这与已知的进展促进剂无关，因此肾小管标志物的测量并不能提供额外的预后信息。
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