Garg Vikas, Kumar Manish, Mahapatra Himansu Sekhar, Chitkara Anubhuti, Gadpayle Adesh Kumar, Sekhar Venketansan
Room No 307, Admin Block, PGIMER, Dr RML Hospital, New Delhi, India.
Clin Exp Nephrol. 2015 Oct;19(5):895-900. doi: 10.1007/s10157-015-1085-3. Epub 2015 Jan 30.
Renal involvement was thought to occur more than 10 years after onset of diabetes, but recent studies provide evidence that it starts even in the pre-diabetes stage. However, there is no sensitive marker to detect these changes at such early stages. Novel urinary biomarkers have showed promising results in detection of early nephropathy in pre-diabetics.
A total of 91 subjects (diabetes 61 and pre-diabetes 30) were enrolled into the study. Urinary biomarkers such as urine Neutrophil Gelatinase-Associated Lipocalin (NGAL), urine Cystatin C and urine albumin-creatinine ratio (UACR) were estimated. Subjects were further divided in four groups on the basis of UACR: pre-diabetes with normoalbuminuria (21); pre-diabetes with microalbuminuria (9); diabetes with normoalbuminuria (37); and diabetes with microalbuminuria (24). The relationship of UACR, NGAL, and Cystatin C was estimated.
Urine levels of NGAL and Cystatin C were significantly higher in microalbuminuria group compared to normoalbuminuria. UACR was positively correlated to urine NGAL-creatinine ratio (UNCR) and urine Cystatin C-creatinine ratio (UCCR) in both diabetes and pre-diabetes. On logistic regression odds ratio of UNCR to predict microalbuminuria in diabetes and pre-diabetes was 1.070 (p = 0.000) and 1.138 (p = 0.010), respectively. Area under curve was determined by ROC analysis, and UNCR was found to be better than UCCR for estimating microalbuminuria.
Tubular damage may play major role in development of nephropathy in pre-diabetes. Newer markers like urine NGAL and Cystatin C are raised early in diabetes and pre-diabetes nephropathy.
以往认为糖尿病发病10年以上才会出现肾脏受累，但近期研究表明，肾脏受累甚至在糖尿病前期就已开始。然而，在如此早期阶段尚无敏感标志物来检测这些变化。新型尿液生物标志物在检测糖尿病前期患者的早期肾病方面已显示出有前景的结果。
共有91名受试者（糖尿病患者61名，糖尿病前期患者30名）纳入本研究。评估了尿液中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、尿胱抑素C和尿白蛋白肌酐比值（UACR）等尿液生物标志物。根据UACR将受试者进一步分为四组：糖尿病前期伴正常白蛋白尿组（21名）；糖尿病前期伴微量白蛋白尿组（9名）；糖尿病伴正常白蛋白尿组（37名）；糖尿病伴微量白蛋白尿组（24名）。评估了UACR、NGAL和胱抑素C之间的关系。
与正常白蛋白尿组相比，微量白蛋白尿组的尿液NGAL和胱抑素C水平显著更高。在糖尿病和糖尿病前期患者中，UACR与尿NGAL肌酐比值（UNCR）和尿胱抑素C肌酐比值（UCCR）均呈正相关。在逻辑回归分析中，糖尿病和糖尿病前期患者中UNCR预测微量白蛋白尿的比值比分别为1.070（p = 0.000）和1.138（p = 0.010）。通过ROC分析确定曲线下面积，发现UNCR在估计微量白蛋白尿方面优于UCCR。
肾小管损伤可能在糖尿病前期肾病的发生中起主要作用。尿液NGAL和胱抑素C等新型标志物在糖尿病和糖尿病前期肾病早期即升高。
