Department of General Practice, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
Department of Clinical Laboratory, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
Nephrology (Carlton). 2021 May;26(5):400-407. doi: 10.1111/nep.13851. Epub 2021 Feb 2.
Various studies have reported that urinary neutrophil gelatinase-associated lipocalin (NGAL), an indicator of tubular damage, may be an effective biomarker of renal impairment in patients with diabetes. This study aimed to compare the ability of urinary alpha-1-microglobulin (a traditional tubular damage marker) with NGAL for evaluating renal insufficiency in patients with type-2 diabetes.
Urinary albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) were used to determine whether 513 participants with type-2 diabetes had renal dysfunction. Urinary alpha-1-microglobulin-to-creatinine ratio (A1MCR) and NGAL-to-creatinine ratio (NCR) were calculated.
Although both A1MCR and NCR were significantly higher among participants with renal insufficiency than among participants without renal damage, the difference in A1MCR values between participants with and without renal insufficiency was relatively greater than the difference in NCR values, especially among the male subjects. The correlation of ACR or eGFR with A1MCR was stronger than that of ACR or eGFR with NCR. A1MCR showed a good capability for detecting renal dysfunction (area under the curve = 0.80), its cut-off value was 14.82 mg/g, corresponding to 71.4% sensitivity and 73.1% specificity. The diagnostic efficiency of A1MCR was significantly higher than that of NCR.
The results indicated that the traditional tubular damage marker A1MCR was more significantly associated with renal insufficiency defined by ACR and/or eGFR and may have a higher diagnostic efficiency compared with the efficiency of NCR in patients with type-2 diabetes.
多项研究表明，尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是肾小管损伤的标志物，可能是糖尿病患者肾损伤的有效生物标志物。本研究旨在比较尿α-1-微球蛋白（一种传统的肾小管损伤标志物）与 NGAL 评估 2 型糖尿病患者肾功能不全的能力。
使用尿白蛋白与肌酐比值（ACR）和估算肾小球滤过率（eGFR）来确定 513 例 2 型糖尿病患者是否存在肾功能障碍。计算尿α-1-微球蛋白与肌酐比值（A1MCR）和 NGAL 与肌酐比值（NCR）。
虽然肾功能不全患者的 A1MCR 和 NCR 均显著高于无肾损伤患者，但 A1MCR 组间差值大于 NCR 组间差值，特别是在男性患者中。ACR 或 eGFR 与 A1MCR 的相关性强于 ACR 或 eGFR 与 NCR 的相关性。A1MCR 检测肾功能不全的能力较好（曲线下面积=0.80），其截断值为 14.82mg/g，对应 71.4%的敏感性和 73.1%的特异性。A1MCR 的诊断效率明显高于 NCR。
结果表明，传统的肾小管损伤标志物 A1MCR 与 ACR 和/或 eGFR 定义的肾功能不全的相关性更显著，与 2 型糖尿病患者的 NCR 相比，其诊断效率可能更高。
