Huh Ji Hye, Lee Minyoung, Park So Young, Kim Jae Hyeon, Lee Byung Wan
Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Diabetes Metab J. 2018 May 2.
The aim of this study was to investigate which glycemic parameters better reflect urinary N-acetyl-β-D-glucosaminidase (uNAG) abnormality, a marker for renal tubulopathy, in subjects with type 2 diabetes mellitus (T2DM) subjects with normoalbuminuria and a normal estimated glomerular filtration rate (eGFR).
We classified 1,061 participants with T2DM into two groups according to uNAG level-normal vs. high (>5.8 U/g creatinine)-and measured their biochemical parameters.
Subjects with high uNAG level had significantly higher levels of fasting and stimulated glucose, glycated albumin (GA), and glycosylated hemoglobin (HbA1c) and lower levels of homeostasis model assessment of β-cell compared with subjects with normal uNAG level. Multiple linear regression analyses showed that uNAG was significantly associated with GA (standardized β coefficient [β]=0.213, P=0.016), but not with HbA1c (β=-0.137, P=0.096) or stimulated glucose (β=0.095, P=0.140) after adjusting confounding factors. In receiver operating characteristic analysis, the value of the area under the curve (AUC) for renal tubular injury of GA was significantly higher (AUC=0.634; 95% confidence interval [CI], 0.646 to 0.899) than those for HbA1c (AUC=0.598; 95% CI, 0.553 to 0.640), stimulated glucose (AUC=0.594; 95% CI, 0.552 to 0.636), or fasting glucose (AUC=0.558; 95% CI, 0.515 to 0.600). The optimal GA cutoff point for renal tubular damage was 17.55% (sensitivity 59%, specificity 62%).
GA is a more useful glycation index than HbA1c for reflecting renal tubulopathy in subjects with T2DM with normoalbuminuria and normal eGFR.
本研究旨在调查在2型糖尿病（T2DM）且尿白蛋白正常和估计肾小球滤过率（eGFR）正常的受试者中，哪些血糖参数能更好地反映肾小管病变标志物——尿N-乙酰-β-D-氨基葡萄糖苷酶（uNAG）异常。
我们根据uNAG水平（正常与高值[>5.8 U/g肌酐]）将1061名T2DM参与者分为两组，并测量他们的生化参数。
与uNAG水平正常的受试者相比，uNAG水平高的受试者空腹和刺激后血糖、糖化白蛋白（GA）和糖化血红蛋白（HbA1c）水平显著更高，而β细胞稳态模型评估水平更低。多元线性回归分析显示，在调整混杂因素后，uNAG与GA显著相关（标准化β系数[β]=0.213，P=0.016），但与HbA1c（β=-0.137，P=0.096）或刺激后血糖（β=0.095，P=0.140）无关。在受试者工作特征分析中，GA用于肾小管损伤的曲线下面积（AUC）值（AUC=0.634；95%置信区间[CI]，0.646至0.899）显著高于HbA1c（AUC=0.598；95%CI，0.553至0.640）、刺激后血糖（AUC=0.594；95%CI，0.552至0.636）或空腹血糖（AUC=0.558；95%CI，0.515至0.600）。肾小管损伤的最佳GA切点为17.55%（敏感性59%，特异性62%）。
对于反映尿白蛋白正常和eGFR正常 的T2DM受试者的肾小管病变，GA是比HbA1c更有用的糖化指标。
