Habashy Safinaz El, Adly Amira Abd El Monem, Abdel Kader Mohamed Salah Eldin Mohamed, Ali Sherine El-Tokhy
Department of Paediatrics, Faculty of Medicine, Ain Shams University, Cair, Egypt.
Department of Paediatrics, Faculty of Medicine, Misr University of Science and Technology (MUST), Giza, Egypt.
Arch Med Sci Atheroscler Dis. 2019 Dec 31;4:e286-e297. doi: 10.5114/amsad.2019.91433. eCollection 2019.
The present study was designed to assess the validity and efficacy of urinary markers (NAG, RBP, transferrin, α1-microglobulin, and plasma homocysteine) as early predictors of microalbuminuria in diabetic nephropathy in children and adolescents with type-1 diabetes, and its relation with haemoglobin glycated (HbA), serum lipid profile, and blood pressure.
This study is a follow-up study to the 2002 study by Salem . The present study included 35 type 1 diabetes mellitus (T1DM) children and adolescents recruited from regular attendees of the specialised Diabetology Clinic, Children's hospital, Ain Shams University, with previously measured urinary -acetyl-β-glucosaminidase (13) or homocysteine (11) or transferrin (28) or α1-microglobulin (27) or retinol binding protein (13) as an early predictor of diabetic nephropathy in T1DM. Thirty-five patients with type 1 diabetes mellitus were enrolled, and 24 patients were normoalbuminuric at baseline. The patients were tested for markers other than urinary microalbumin, to predict diabetic nephropathy and early renal impairment in children and adolescents with type 1 diabetes mellitus.
Regarding the metabolic control between the studied groups, we found that there is significant difference in HbA between the microalbuminuric patients and the normoalbuminuric patients. According to the number of positive markers of diabetic nephropathy, the only parameter that was higher in patients with more than one elevated marker was mean systolic blood pressure. Although mean diabetic blood pressure was higher, it was not statistically significant. Regarding to the predictability of urinary markers, urinary -acetyl-β-glucosaminidase is the most predictable marker with high sensitivity and specificity. The least sensitivity noticed was urinary RBP and the least specificity noticed was urinary α1-microglobulin.
Regarding the predictability of urinary markers, urinary NAG is the most predictable marker with both high sensitivity and specificity, with a sensitivity of 60%, specificity 75%, positive predictive value 60%, negative predictive value 75%, and a diagnostic accuracy of 0.58%. Urinary RBP is another marker with low sensitivity but high specificity. Urinary α1-microglobulin is a valid marker with high sensitivity but low specificity. Contrary to previous markers, plasma homocysteine has high specificity but low sensitivity.
本研究旨在评估尿标志物（N-乙酰-β-氨基葡萄糖苷酶、视黄醇结合蛋白、转铁蛋白、α1-微球蛋白和血浆同型半胱氨酸）作为1型糖尿病儿童和青少年糖尿病肾病微量白蛋白尿早期预测指标的有效性和效能，及其与糖化血红蛋白、血脂谱和血压的关系。
本研究是对Salem 2002年研究的随访研究。本研究纳入了35例1型糖尿病（T1DM）儿童和青少年，他们来自艾因夏姆斯大学儿童医院糖尿病专科门诊的定期就诊者，之前已检测过尿N-乙酰-β-氨基葡萄糖苷酶（13例）、同型半胱氨酸（11例）、转铁蛋白（28例）、α1-微球蛋白（27例）或视黄醇结合蛋白（13例），作为T1DM糖尿病肾病的早期预测指标。纳入了35例1型糖尿病患者，24例患者在基线时尿白蛋白正常。对患者进行尿微量白蛋白以外的标志物检测，以预测1型糖尿病儿童和青少年的糖尿病肾病和早期肾功能损害。
关于研究组之间的代谢控制情况，我们发现微量白蛋白尿患者和尿白蛋白正常患者之间糖化血红蛋白存在显著差异。根据糖尿病肾病阳性标志物的数量，唯一在有一个以上升高标志物的患者中较高的参数是平均收缩压。虽然糖尿病平均血压较高，但无统计学意义。关于尿标志物的预测能力，尿N-乙酰-β-氨基葡萄糖苷酶是最具预测性的标志物，具有高敏感性和特异性。观察到的最低敏感性是尿视黄醇结合蛋白，最低特异性是尿α1-微球蛋白。
关于尿标志物的预测能力，尿N-乙酰-β-氨基葡萄糖苷酶是最具预测性的标志物，具有高敏感性和特异性，敏感性为60%，特异性为
