Zeng Xian-Fei, Lu Dong-Xue, Li Jun-Min, Tan Yun, Li Zhuo, Zhou Lei, Xi Zeng-Qian, Zhang Shu-Miao, Duan Wei
Department of Laboratory Medicine and Blood Transfusion, Shaanxi Corps Hospital, Chinese People's Armed Police Forces, Xi'an, 710054, China.
Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
BMC Nephrol. 2017 Jul 12;18(1):233. doi: 10.1186/s12882-017-0620-8.
Tubular biomarkers have been regarded as emerging and promising markers for early diagnosis of diabetic kidney disease (DKD). The study was to determine the diagnostic capabilities of tubular biomarkers (urinary neutrophil gelatinase-associated lipocalin [NGAL], clusterin, and cystatin C) for DKD and diabetic microalbuminuria, and whether or not the tubular biomarkers appear earlier than microalbuminuria.
In this consecutive cohort study, 146 type 2 diabetes mellitus (T2DM) patients with a disease duration of ≥6 years were enrolled. Thirty age- and gender-matched subjects without any systemic diseases were recruited as the control group. Urinary samples collected before treatment were tested for NGAL, clusterin, and cystatin C.
The levels of biomarkers were higher in patients with DKD (p < 0.001); and positively correlated with the urinary albumin creatinine ratio (UACR; p < 0.001). With respect to the diagnosis of DKD, the areas under the receiver operating characteristic curve (AUCs) for urinary NGAL, clusterin, and cystatin C were 0.816 (95% confidence interval [CI], 0.741-0.891), 0.775 (95% CI: 0.694-0.857), and 0.803 (95% CI: 0.722-0.884), respectively. The levels of urinary NGAL and cystatin C in the normoalbuminuria group (UACR <30 mg /g•Cr) were elevated compared with the control group, unlike urinary clusterin. There was no statistical difference in the levels of the three biomarkers between groups with different levels of haemoglobin A (HbA). The diagnostic AUCs for urinary NGAL, clusterin, and cystatin C in patients with diabetic microalbuminuria were 0.841 (95% CI: 0.775-0.907), 0.783(95% CI: 0.710-0.856), and 0.805 (95% CI: 0.733-0.877), respectively.
Urinary NGAL, clusterin, and cystatin C may be promising biomarkers for diagnosing DKD and diabetic microalbuminuria. It is possible that urinary NGAL and cystatin C increase before the onset of microalbuminuria in T2DM patients.
肾小管生物标志物被视为糖尿病肾病（DKD）早期诊断中新兴且有前景的标志物。本研究旨在确定肾小管生物标志物（尿中性粒细胞明胶酶相关脂质运载蛋白[NGAL]、簇集素和胱抑素C）对DKD和糖尿病微量白蛋白尿的诊断能力，以及这些肾小管生物标志物是否比微量白蛋白尿更早出现。
在这项连续性队列研究中，纳入了146例病程≥6年的2型糖尿病（T2DM）患者。招募了30名年龄和性别匹配、无任何全身性疾病的受试者作为对照组。检测治疗前采集的尿液样本中的NGAL、簇集素和胱抑素C。
DKD患者的生物标志物水平更高（p<0.001）；且与尿白蛋白肌酐比值（UACR；p<0.001）呈正相关。关于DKD的诊断，尿NGAL、簇集素和胱抑素C的受试者工作特征曲线下面积（AUC）分别为0.816（95%置信区间[CI]，0.741 - 0.891）、0.775（95%CI：0.694 - 0.857）和0.803（95%CI：0.722 - 0.884）。与对照组相比，正常白蛋白尿组（UACR<30mg/g•Cr）的尿NGAL和胱抑素C水平升高，而尿簇集素则不然。不同糖化血红蛋白（HbA）水平组之间这三种生物标志物的水平无统计学差异。糖尿病微量白蛋白尿患者尿NGAL、簇集素和胱抑素C的诊断AUC分别为0.841（95%CI：0.775 - 0.907）、0.783（95%CI：0.710 - 0.856）和0.805（95%CI：0.733 - 0.877）。
尿NGAL、簇集素和胱抑素C可能是诊断DKD和糖尿病微量白蛋白尿的有前景的生物标志物。在T2DM患者中，尿NGAL和胱抑素C有可能在微量白蛋白尿发作之前升高。
