Central Laboratory, Jinhua Municipal Central Hospital, Jinhua, China.
Hangzhou Medical College, Zhejiang, China.
Nephrology (Carlton). 2020 Sep;25(9):667-675. doi: 10.1111/nep.13707. Epub 2020 Mar 24.
Early screening of diabetic kidney disease (DKD) remains a major challenge. Our aim was to evaluate the value of urinary orosomucoid 1 protein (UORM1) in early renal impairment screening in type-2 diabetes patients.
The concentration of UORM1, the UORM1-to-creatinine ratio (UORM1CR), the urinary albumin-to-creatinine ratio (ACR), the alpha-1-microglobulin-to-creatinine ratio (A1MCR) and estimated glomerular filtration rate (eGFR) were measured in 406 type-2 diabetes patients. Any positive values for ACR, A1MCR and/or eGFR were considered as indicative of renal impairment.
On average, the levels of UORM1 and UORM1CR were about seven times higher in subjects with renal injury than in those without. Both UORM1 and UORM1CR, when adjusted via logarithm-transformation, were significantly related to ACR, A1MCR and eGFR levels. The highest correlation was observed between UORM1CR and A1MCR (r = 0.85, P < .001). The cut-off values for UORM1 (2.53 mg/L) and UORM1CR (3.69 mg/g) for the early diagnosis of kidney impairment were obtained from receiver operating characteristic curves. UORM1CR obviously had higher diagnostic efficiency corresponding to 83.26% sensitivity and 90.32% specificity than UORM1. Likewise, its sensitivity was higher than those of ACR, A1MCR and eGFR. Bad glycaemic control had the highest risk of increased UORM1CR (odds ratio [OR] = 2.81, P < .001), while high HDL-C (high-density lipoprotein cholesterol) decreased the risk of increased UORM1CR (OR = 0.38, P = .017).
The UORM1CR (>3.69 mg/g) has the high diagnostic efficiency for the early screening of renal impairment in type-2 diabetes patients. Furthermore, good glycaemic control and high HDL-C might be protective factors against UORM1CR increase.
早期筛查糖尿病肾病（DKD）仍然是一个主要挑战。我们的目的是评估尿粘蛋白 1 蛋白（UORM1）在 2 型糖尿病患者早期肾损害筛查中的价值。
在 406 例 2 型糖尿病患者中测量 UORM1、UORM1 与肌酐比（UORM1CR）、尿白蛋白与肌酐比（ACR）、α-1-微球蛋白与肌酐比（A1MCR）和估计肾小球滤过率（eGFR）。任何 ACR、A1MCR 和/或 eGFR 的阳性值均被认为是肾损害的指标。
平均而言，有肾损伤的患者的 UORM1 和 UORM1CR 水平比无肾损伤的患者高约 7 倍。经对数转换调整后，UORM1 和 UORM1CR 均与 ACR、A1MCR 和 eGFR 水平显著相关。UORM1CR 与 A1MCR 之间的相关性最高（r = 0.85，P < 0.001）。通过受试者工作特征曲线获得 UORM1（2.53 mg/L）和 UORM1CR（3.69 mg/g）用于早期诊断肾损害的截断值。UORM1CR 的诊断效率明显高于 UORM1，其敏感性为 83.26%，特异性为 90.32%。同样，其敏感性高于 ACR、A1MCR 和 eGFR。血糖控制不佳时 UORM1CR 升高的风险最高（优势比[OR] = 2.81，P < 0.001），而高密度脂蛋白胆固醇（HDL-C）升高则降低了 UORM1CR 升高的风险（OR = 0.38，P = 0.017）。
UORM1CR（>3.69 mg/g）对 2 型糖尿病患者肾损害的早期筛查具有较高的诊断效率。此外，良好的血糖控制和高 HDL-C 可能是 UORM1CR 升高的保护因素。
