Elsheikh Mohamed, Elhefnawy Khaled A, Emad George, Ismail Mabrouk, Borai Maher
Faculty of Medicine, Internal Medicine Department, Zagazig University, Egypt.
Faculty of Medicine, Clinical Pathology Department, Zagazig University, Egypt.
J Bras Nefrol. 2019 Oct-Dec;41(4):509-517. doi: 10.1590/2175-8239-JBN-2018-0200.
Although microalbuminuria remains the gold standard for early detection of diabetic nephropathy (DN), it is not a sufficiently accurate predictor of DN risk. Thus, new biomarkers that would help to predict DN risk earlier and possibly prevent the occurrence of end-stage kidney disease are being investigated.
To investigate the role of zinc-alpha-2-glycoprotein (ZAG) as an early marker of DN in type 2 diabetic (T2DM) patients.
88 persons were included and classified into 4 groups: Control group (group I), composed of normal healthy volunteers, and three patient groups with type 2 diabetes mellitus divided into: normo-albuminuria group (group II), subdivided into normal eGFR subgroup and increased eGFR subgroup > 120 mL/min/1.73m2), microalbuminuria group (group III), and macroalbuminuria group (group IV). All subjects were submitted to urine analysis, blood glucose levels, HbA1c, liver function tests, serum creatinine, uric acid, lipid profile and calculation of eGFR, urinary albumin creatinine ratio (UACR), and measurement of urinary and serum ZAG.
The levels of serum and urine ZAG were higher in patients with T2DM compared to control subjects and a statistically significant difference among studied groups regarding serum and urinary ZAG was found. Urine ZAG levels were positively correlated with UACR. Both ZAG levels were negatively correlated with eGFR. Urine ZAG levels in the eGFR ˃ 120 mL/min/1.73m2 subgroup were higher than that in the normal eGFR subgroup.
These findings suggest that urine and serum ZAG might be useful as early biomarkers for detection of DN in T2DM patients, detectable earlier than microalbuminuria.
尽管微量白蛋白尿仍是早期检测糖尿病肾病（DN）的金标准，但它并非DN风险的充分准确预测指标。因此，人们正在研究有助于更早预测DN风险并可能预防终末期肾病发生的新生物标志物。
探讨锌-α-2-糖蛋白（ZAG）作为2型糖尿病（T2DM）患者DN早期标志物的作用。
纳入88人，分为4组：对照组（I组），由正常健康志愿者组成；3个2型糖尿病患者组，分为：正常白蛋白尿组（II组），再细分为正常估算肾小球滤过率（eGFR）亚组和eGFR升高亚组（>120 mL/min/1.73m2）、微量白蛋白尿组（III组）和大量白蛋白尿组（IV组）。所有受试者均接受尿液分析、血糖水平、糖化血红蛋白（HbA1c）、肝功能检查、血清肌酐、尿酸、血脂谱检测，并计算eGFR、尿白蛋白肌酐比值（UACR），以及检测尿和血清ZAG。
与对照组相比，T2DM患者的血清和尿ZAG水平更高，且在研究组之间发现血清和尿ZAG存在统计学显著差异。尿ZAG水平与UACR呈正相关。两种ZAG水平均与eGFR呈负相关。eGFR>120 mL/min/1.73m2亚组的尿ZAG水平高于正常eGFR亚组。
这些发现表明，尿和血清ZAG可能作为T2DM患者DN检测的早期生物标志物，比微量白蛋白尿更早可检测到。
