Sisman Pinar, Gul Ozen O, Dirican Melahat, Bal Ahmet S, Cander Soner, Erturk Erdinc
Clin Lab. 2020 Jan 1;66(1). doi: 10.7754/Clin.Lab.2019.190326.
Glomerular and tubulointerstitial damage plays a role in renal function failure in diabetic patients. While both serum and urine levels of neutrophil gelatinase-associated lipocalin (NGAL) show significantly increased levels in acute renal pathologies, the NGAL increase in active phase indicates a reversible condition in chronic cases.
52 type 1 diabetic patients and 30 healthy volunteers participated in the study. The diabetic participants were separated into two groups as follows: a normoalbuminuria group consisting of those with an albumin/creatinine ratio less than 30 mg/g and an albuminuria group consisting of those with an albumin/ creatinine ratio equal or greater than 30 mg/g. Albumin, creatinine and NGAL were measured in all participants.
Urinary NGAL median level was 21.1 ng/mL for diabetic patients and 11.9 ng/mL for healthy controls, and the difference between the two groups was statistically significant. When diabetic patients were compared as those with and without albuminuria, the median urinary NGAL levels of normoalbuminuria and albuminuria were 24.7 and 16.1 ng/mL, respectively, but the difference was not statistically significant. Statistically similar results were obtained through evaluation of the ratio of urinary NGAL excretion to creatinine excretion. The NGAL/Cr ratio was significantly higher in diabetic patients than in healthy controls, but no statistically significant difference was found between the diabetic patients with and without albuminuria.
Urinary NGAL excretion in type 1 diabetic patients is found to be increased over a wide range, but it does not correlate with urinary albumin excretion. In this regard, urinary NGAL excretion should not be used as an alternative to microalbuminuria in detecting diabetic nephropathy. The greater amount of NGAL excretion among diabetic patients may be due to diabetic nephropathy with possible tubulointerstitial damage pathologies.
肾小球和肾小管间质损伤在糖尿病患者肾功能衰竭中起作用。虽然中性粒细胞明胶酶相关脂质运载蛋白（NGAL）的血清和尿液水平在急性肾脏病变中均显著升高，但在慢性病例中，活跃期NGAL升高表明病情可逆。
52例1型糖尿病患者和30名健康志愿者参与了该研究。糖尿病参与者被分为以下两组：白蛋白/肌酐比值小于30mg/g的正常白蛋白尿组和白蛋白/肌酐比值等于或大于30mg/g的白蛋白尿组。对所有参与者测量白蛋白、肌酐和NGAL。
糖尿病患者尿NGAL中位数水平为21.1ng/mL，健康对照组为11.9ng/mL，两组之间的差异具有统计学意义。当将糖尿病患者按有无白蛋白尿进行比较时，正常白蛋白尿组和白蛋白尿组的尿NGAL中位数水平分别为24.7和16.1ng/mL，但差异无统计学意义。通过评估尿NGAL排泄与肌酐排泄的比值获得了统计学上相似的结果。糖尿病患者的NGAL/Cr比值显著高于健康对照组，但有白蛋白尿和无白蛋白尿的糖尿病患者之间未发现统计学上的显著差异。
发现1型糖尿病患者的尿NGAL排泄在很大范围内增加，但它与尿白蛋白排泄无关。在这方面，尿NGAL排泄不应作为检测糖尿病肾病时微量白蛋白尿的替代指标。糖尿病患者中NGAL排泄量增加可能是由于伴有可能的肾小管间质损伤病变的糖尿病肾病。
