Zhuang Zhen, Bai Qiong, A Lata, Liang Yaoxian, Zheng Danxia, Wang Yue
Department of Nephrology, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University Beijing, China.
The No. 3 Hospital of Peking University Beijing, China.
Int J Clin Exp Pathol. 2015 Sep 1;8(9):11464-9. eCollection 2015.
It was previously reported that intrarenal renin angiotensin system (RAS) plays a pivotal role in the onset and progression of diabetic nephropathy (DN). Urinary angiotensinogen (UAGT) was employed as a special index of the intrarenal RAS status and enhanced significantly at a very early stage of chronic kidney disease and type 1 diabetes. On the basis of these findings, the present study was performed to test the hypothesis that UAGT levels are increase even before the development of DN in type 2 diabetic patients without hypertension. 102 patients with type 2 diabetes mellitus (T2DM) and 18 healthy volunteers were studied cross-sectionally. Clinical data were collected and morning spot urine samples were obtained from all participants. UAGT levels were detected by an enzyme-linked immunosorbent assay (ELISA). As a result, UAGT to creatinine ratio (UAGT/Cr) was significantly enhanced in T2DM patients before the appearance of urinary albumin (UALB) and further increased to a greater degree in albuminuric patients. UAGT/Cr levels were positively correlated with Log (UALB to creatinine ratio) and diastolic blood pressure, but negatively correlated with estimated glomerular filtration rate. These data indicate that elevated UAGT levels precede the onset of albuminuria in normotensive T2DM patients. UAGT might potentially serve as an early marker to determine intrarenal RAS activity and predict progressive kidney disease in T2DM patients without hypertension.
此前有报道称，肾内肾素血管紧张素系统（RAS）在糖尿病肾病（DN）的发生和发展中起关键作用。尿血管紧张素原（UAGT）被用作肾内RAS状态的一个特殊指标，在慢性肾脏病和1型糖尿病的极早期就显著升高。基于这些发现，本研究旨在验证以下假设：在无高血压的2型糖尿病患者中，UAGT水平在DN发生之前就升高。对102例2型糖尿病（T2DM）患者和18名健康志愿者进行了横断面研究。收集了临床数据，并从所有参与者中获取了晨尿样本。通过酶联免疫吸附测定（ELISA）检测UAGT水平。结果显示，在出现尿白蛋白（UALB）之前，T2DM患者的UAGT与肌酐比值（UAGT/Cr）就显著升高，在蛋白尿患者中进一步大幅升高。UAGT/Cr水平与Log（UALB与肌酐比值）和舒张压呈正相关，但与估计肾小球滤过率呈负相关。这些数据表明，在血压正常的T2DM患者中，UAGT水平在蛋白尿出现之前就已升高。UAGT可能作为一种早期标志物，用于确定肾内RAS活性，并预测无高血压的T2DM患者的进行性肾脏疾病。
