Department of Internal Medicine, University of Messina, Messina, Italy,
Acta Diabetol. 2013 Dec;50(6):935-42. doi: 10.1007/s00592-013-0485-7. Epub 2013 Jun 11.
The aim of this study was to demonstrate that neutrophil gelatinase-associated lipocalin (NGAL) increased before the onset of microalbuminuria in patients with type 1 diabetes mellitus (T1DM), representing an important biochemical parameter with high sensitivity and specificity to make a precocious diagnosis of "normoalbuminuric" diabetic nephropathy (DN). Serum NGAL (sNGAL) and urinary NGAL (uNGAL) levels were evaluated in a cohort of fifty patients affected by T1DM. They had no signs of clinical nephropathy. Thirty-five healthy subjects (HS) were recruited. sNGAL levels were significantly higher compared with those measured in HS [193.7 (103.2-405.4) vs. 46.4 (39.8-56.2) ng/ml; p < 0.0001], as were uNGAL levels [25.5 (14.2-40.2) vs. 6.5 (2.9-8.5) ng/ml; p < 0.0001]. sNGAL was found to be directly correlated with glycated hemoglobin. uNGAL also positively correlated with albuminuria, whereas an inverse correlation was found with uric acid. After multivariate analysis, significance was maintained for the correlation between uNGAL and microalbuminuria. In ROC analysis, sNGAL showed a good diagnostic profile such as uNGAL. NGAL increases in patients with T1DM, even before diagnosis of microalbuminuria representing an early biomarker of "normoalbuminuric" DN with a good sensitivity and specificity. NGAL measurement could be useful for the evaluation of early renal involvement in the course of diabetes.
本研究旨在证明，1 型糖尿病（T1DM）患者的中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在微量白蛋白尿之前升高，这代表了一种具有高灵敏度和特异性的重要生化参数，可以对“正常白蛋白尿”糖尿病肾病（DN）进行早期诊断。在 50 名 T1DM 患者的队列中评估了血清 NGAL（sNGAL）和尿 NGAL（uNGAL）水平。他们没有临床肾病的迹象。招募了 35 名健康受试者（HS）。sNGAL 水平明显高于 HS 测量值[193.7（103.2-405.4）vs.46.4（39.8-56.2）ng/ml；p<0.0001]，uNGAL 水平也明显升高[25.5（14.2-40.2）vs.6.5（2.9-8.5）ng/ml；p<0.0001]。sNGAL 与糖化血红蛋白呈直接相关。uNGAL 也与蛋白尿呈正相关，而与尿酸呈负相关。多变量分析后，uNGAL 与微量白蛋白尿之间的相关性仍然具有统计学意义。在 ROC 分析中，sNGAL 显示出与 uNGAL 相似的良好诊断特征。T1DM 患者的 NGAL 升高，甚至在微量白蛋白尿之前就升高，代表“正常白蛋白尿”DN 的早期生物标志物，具有良好的灵敏度和特异性。NGAL 测量可能有助于评估糖尿病病程中肾脏的早期受累情况。
