Guo Kai-feng, Kou Jing-xin, Lu Jun-xi, Zhang Lei, Yu Hao-yong, Chen Hai-bing
Department of Endocrinology & Metabolism, Shanghai Clinical Center for Diabetes, Shanghai, China.
Zhonghua Yi Xue Za Zhi. 2013 Apr 9;93(14):1067-71.
To explore the significance of urinary smad3(usmad3) protein level change in diabetic nephropathy (DN) in type 2 diabetes mellitus and examine its relationship with the progression of DN.
From May 2010 to August 2011, a total of 282 patients with type 2 diabetes were selected for the experimental group according to instant urine specimen albumin-creatinine ratio (UACR). Another 100 healthy subjects were taken as the control group. Then the diabetics were divided into 3 groups, including 110 with normal albuminuria (NA group), 114 with microalbuminuria (MA group) and 58 with macroalbuminuria (DN group). Enzyme-linked immunosorbent assay (ELISA) was used to detect the content of usmad3. The parameters of age, systolic blood pressure, body mass index (BMI), blood glucose, blood lipids, urinary albumin/creatinine (ACR), estimated glomerular filtration rate (eGFR) and glycosylated hemoglobin were measured. And non-mydriatic fundus camera was used to evaluate retinopathy, the DN group (n = 58) was then divided into two groups of those without retinopathy (n = 25) and with retinopathy (n = 33).
(1) The usmad3 level in type 2 diabetes group was significantly higher than that in the control group (489(273,1193) vs 311 (179, 497) ng/mmol Cr (P < 0.01). (2) According to UACR, type 2 diabetes group was divided into 3 different groups to compare the relative level differences of usmad3 in different groups: MA group versus NA group, 552 (316,1338) vs 317 (200,594), DN group versus NA group, 1035 (503,3035)vs 317 (200,594), DN group versus MA group, 1035(503,3035)vs 552(316,1338), all P < 0.01. (3) Pearson correlation test showed the level of usmad3 was significantly correlated with age, SBP, HbA1c, blood urea nitrogen, creatinine, total cholesterol, low density lipoprotein, eGFR and UACR (r = 0.57, P < 0.01). And multiple linear regression analysis showed that usmad3 and UACR were independently correlated (β = 0.754, P < 0.01). (4) The usmad3 level in DN with retinopathy were significantly higher than that in DN without retinopathy (1905(806,4303) vs 595 (331,1183), P < 0.01). No significant difference existed in uACR level between DN with retinopathy and DN without retinopathy(P > 0.05).
Urinary level of smad3 is significantly elevated in type 2 diabetics and it is significantly associated with ACR. It suggests that usmad3 is a potential marker in the diagnosis of DN and may be used to predict the severity of DN.
探讨2型糖尿病患者糖尿病肾病（DN）中尿Smad3（uSmad3）蛋白水平变化的意义，并研究其与DN进展的关系。
2010年5月至2011年8月，根据即时尿标本白蛋白肌酐比值（UACR）选取282例2型糖尿病患者作为实验组。另选100例健康受试者作为对照组。将糖尿病患者分为3组，包括110例正常白蛋白尿组（NA组）、114例微量白蛋白尿组（MA组）和58例大量白蛋白尿组（DN组）。采用酶联免疫吸附测定（ELISA）法检测uSmad3含量。测量年龄、收缩压、体重指数（BMI）、血糖、血脂、尿白蛋白/肌酐（ACR）、估算肾小球滤过率（eGFR）和糖化血红蛋白等参数。使用免散瞳眼底照相机评估视网膜病变，将DN组（n = 58）分为无视网膜病变组（n = 25）和有视网膜病变组（n = 33）。
（1）2型糖尿病组uSmad3水平显著高于对照组（489（273,1193） vs 311（179, 497）ng/mmol Cr，P < 0.01）。（2）根据UACR将2型糖尿病组分为3个不同组，比较不同组uSmad3的相对水平差异：MA组与NA组，552（316,1338） vs 317（200,594）；DN组与NA组，1035（503,3035）vs 317（200,594）；DN组与MA组，1035（503,3035）vs 552（316,1338），均P < 0.01。（3）Pearson相关检验显示uSmad3水平与年龄、收缩压、糖化血红蛋白、血尿素氮、肌酐、总胆固醇、低密度脂蛋白、eGFR和UACR显著相关（r = 0.57，P < 0.01）。多元线性回归分析显示uSmad3与UACR独立相关（β = 0.754，P < 0.01）。（4）有视网膜病变的DN患者uSmad3水平显著高于无视网膜病变的DN患者（1905（806,4303） vs 595（331,1183），P < 0.01）。有视网膜病变的DN患者与无视网膜病变的DN患者uACR水平无显著差异（P > 0.05）。
2型糖尿病患者尿Smad3水平显著升高，且与ACR显著相关。提示uSmad3是DN诊断的潜在标志物，可用于预测DN的严重程度。
