Bacci Marcelo R, Chehter Ethel Z, Azzalis Ligia A, Costa de Aguiar Alves Beatriz, Fonseca Fernando L A
Department of General Practice, Faculdade de Medicina do ABC, Santo André, Brazil.
Earth Sciense's Department of UNIFESP, São Paulo, Brazil.
Kidney Int Rep. 2016 Oct 15;2(2):152-158. doi: 10.1016/j.ekir.2016.10.001. eCollection 2017 Mar.
Diabetic nephropathy is associated with specific histological changes. Early detection of poor glomerular and tubular function can be achieved with biomarkers of diabetes. The aim of this study was to evaluate the accuracy of kidney dysfunction biomarkers in type 2 diabetes (T2D).
Patients with T2D were grouped according to their glycated hemoglobin level. Patients' urine and blood samples were taken to measure cystatin C (CysC), neutrophil gelatinase-associated lipocalin, beta-trace protein levels, and the first morning void albumin-to-creatinine ratio. Patients in the end stage of renal disease or receiving dialysis were not included. Receiver operating characteristic curves were generated, and the areas under the curve were compared with the performance of the biomarkers used to evaluate kidney dysfunction in T2D.
Ninety patients with T2D were chosen. CysC was positively correlated with creatinine ( < 0.001), estimated glomerular filtration rate ( < 0.001), and urinary beta-trace protein ( = 0.01). The area under the curve was 0.635 for CysC, 0.621 for serum neutrophil gelatinase-associated lipocalin, and 0.660 for the albumin-to-creatinine ratio. A crude logistic regression model showed a positive association between serum CysC ( = 0.01) and serum neutrophil gelatinase-associated lipocalin ( < 0.001). A linear regression model showed a positive association between serum CysC, creatinine, and estimated glomerular filtration rate ( < 0.001) but did not show a positive association with glycated hemoglobin ( = 0.892).
Neutrophil gelatinase-associated lipocalin and serum CysC were positively associated with the presence of renal dysfunction and had better performance on receiver operating characteristic analysis than the other markers evaluated in patients with T2D without kidney dysfunction.
糖尿病肾病与特定的组织学改变相关。通过糖尿病生物标志物可实现对肾小球和肾小管功能不良的早期检测。本研究的目的是评估2型糖尿病（T2D）中肾功能障碍生物标志物的准确性。
根据糖化血红蛋白水平对T2D患者进行分组。采集患者的尿液和血液样本，以测量胱抑素C（CysC）、中性粒细胞明胶酶相关脂质运载蛋白、β-微球蛋白水平以及晨尿白蛋白与肌酐比值。排除处于终末期肾病或接受透析的患者。绘制受试者工作特征曲线，并将曲线下面积与用于评估T2D患者肾功能障碍的生物标志物的性能进行比较。
选取了90例T2D患者。CysC与肌酐（<0.001）、估算肾小球滤过率（<0.001）和尿β-微球蛋白（=0.01）呈正相关。CysC的曲线下面积为0.635，血清中性粒细胞明胶酶相关脂质运载蛋白为0.621，白蛋白与肌酐比值为0.660。一个简单逻辑回归模型显示血清CysC（=0.01）与血清中性粒细胞明胶酶相关脂质运载蛋白（<0.001）之间存在正相关。一个线性回归模型显示血清CysC、肌酐与估算肾小球滤过率之间存在正相关（<0.001），但与糖化血红蛋白无正相关（=0.892）。
中性粒细胞明胶酶相关脂质运载蛋白和血清CysC与肾功能障碍的存在呈正相关，并且在无肾功能障碍的T2D患者中，其在受试者工作特征分析中的表现优于所评估的其他标志物。
