Gibb D M, Tomlinson P A, Dalton N R, Turner C, Shah V, Barratt T M
Department of Paediatric Nephrology, Institute of Child Health, London.
Arch Dis Child. 1989 Jan;64(1):129-34. doi: 10.1136/adc.64.1.129.
The urinary extraction of albumin, retinol binding protein, and N-acetyl-beta-D-glucosaminidase were studied in 60 children with insulin dependent diabetes mellitus and in 45 normal children to find out whether the renal tubules played a part in causing the early increase in urinary excretion of albumin that occurs in diabetes mellitus. Two overnight urine samples were collected and the protein excretion measured and expressed as the geometric mean of the protein to creatinine ratio (urinary albumin:creatinine ratio, urinary retinol binding protein:creatinine ratio, and urinary N-acetyl-beta-D-glucosaminidase:creatinine ratio, respectively). The excretion of all three proteins was significantly higher in the diabetic children with 15 (25%) of urinary albumin:creatinine ratio, 16 (27%) of urinary retinol binding protein:creatinine ratio, and 43 (72%) of urinary N-acetyl-beta-D-glucosaminidase:creatinine ratio values being above the normal range. Significant correlations were observed between urinary albumin:creatinine ratio and urinary retinol binding protein:creatinine ratio, urinary albumin:creatinine ratio and urinary N-acetyl-beta-D-glucosaminidase:creatinine ratio, and urinary retinol binding protein:creatinine ratio and urinary N-acetyl-beta-D-glucosaminidase:creatinine ratio. There were also significant correlations between glycated haemoglobin 1c (HbA1c) and these proteins, especially N-acetyl-beta-D-glucosaminidase. No correlations were observed with the fractional excretion of sodium, flow rate of urine, glomerular filtration rate, or blood pressure. These data show that tubular abnormalities are present early in the course of insulin dependent diabetes mellitus and suggest that the early increase in urinary excretion of albumin may be at least partly tubular in origin, and that glycaemic control may influence this aspect of proximal tubular function.
对60例胰岛素依赖型糖尿病患儿和45例正常儿童的尿中白蛋白、视黄醇结合蛋白及N - 乙酰 - β - D - 氨基葡萄糖苷酶的排泄情况进行了研究，以确定肾小管是否在糖尿病早期白蛋白尿排泄增加中起作用。收集了两份过夜尿液样本，测量蛋白质排泄量，并分别以蛋白质与肌酐比值（尿白蛋白：肌酐比值、尿视黄醇结合蛋白：肌酐比值和尿N - 乙酰 - β - D - 氨基葡萄糖苷酶：肌酐比值）的几何平均值表示。糖尿病患儿这三种蛋白质的排泄量均显著高于正常儿童，尿白蛋白：肌酐比值有15例（25%）、尿视黄醇结合蛋白：肌酐比值有16例（27%）、尿N - 乙酰 - β - D - 氨基葡萄糖苷酶：肌酐比值有43例（72%）高于正常范围。尿白蛋白：肌酐比值与尿视黄醇结合蛋白：肌酐比值、尿白蛋白：肌酐比值与尿N - 乙酰 - β - D - 氨基葡萄糖苷酶：肌酐比值以及尿视黄醇结合蛋白：肌酐比值与尿N - 乙酰 - β - D - 氨基葡萄糖苷酶：肌酐比值之间均存在显著相关性。糖化血红蛋白1c（HbA1c）与这些蛋白质之间也存在显著相关性，尤其是与N - 乙酰 - β - D - 氨基葡萄糖苷酶。未观察到与钠的分数排泄、尿流率、肾小球滤过率或血压之间存在相关性。这些数据表明，在胰岛素依赖型糖尿病病程早期就存在肾小管异常，提示白蛋白尿排泄早期增加可能至少部分源于肾小管，且血糖控制可能会影响近端肾小管功能的这一方面。
