Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.
Pediatr Nephrol. 2022 Dec;37(12):3085-3092. doi: 10.1007/s00467-022-05487-4. Epub 2022 Mar 14.
Early identification of youth with type 1 diabetes (T1D) at risk for diabetic kidney disease may improve clinical outcomes. We examined the cross-sectional relationship between kidney biomarkers neutrophil gelatinase-associated lipocalin (NGAL), copeptin, interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), chitinase-3-like protein-1 (YKL-40), and monocyte chemoattractant protein-1 (MCP-1) and intrarenal hemodynamic function in adolescents with T1D.
Urine albumin-to-creatinine ratio (UACR), renal vascular resistance (RVR), glomerular filtration rate (GFR), intraglomerular pressure (P), efferent arteriole resistance (R), afferent arteriolar resistance (R), and renal plasma flow (RPF), and the above indicated biomarkers were assessed in youth aged 12-21 years with and without T1D of < 10 years duration.
Fifty adolescents with T1D (16.1 ± 3.0 years, HbA1c 8.6 ± 1.2%) and 20 adolescents of comparable BMI without T1D (16.1 ± 2.9 years, HbA1c 5.2 ± 0.2%) were enrolled. Adolescents with T1D demonstrated significantly higher GFR, RPF, R, and P than controls (39%, 33%, 74%, and 29%, respectively, all p < 0.0001). Adolescents with T1D also exhibited significantly lower RVR and R than controls (25% and 155%, respectively, both p < 0.0001). YKL-40 and KIM-1 concentrations, respectively, were positively associated with GFR (r: 0.43, p = 0.002; r: 0.41, p = 0.003), RPF (r: 0.29, p = 0.08; r: 0.34, p = 0.04), UACR (r: 0.33, p = 0.02; r: 0.50, p = 0.0002), and P (r: 0.45, p = 0.006; r: 0.52, p = 0.001) in adolescents with T1D.
Higher concentrations of biomarkers YKL-40 and KIM-1 may help define the risk for intraglomerular hemodynamic dysfunction in youth with T1D. A higher resolution version of the Graphical abstract is available as Supplementary information.
早期识别有发生糖尿病肾病风险的 1 型糖尿病（T1D）青年患者可能会改善临床结局。我们检测了在 T1D 青少年中，肾生物标志物中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、 copeptin、白细胞介素-18（IL-18）、肾损伤分子-1（KIM-1）、几丁质酶-3 样蛋白-1（YKL-40）和单核细胞趋化蛋白-1（MCP-1）与肾内血液动力学功能之间的横断面关系。
检测 12-21 岁青少年的尿白蛋白与肌酐比值（UACR）、肾血管阻力（RVR）、肾小球滤过率（GFR）、肾小球内压（P）、出球小动脉阻力（R）、入球小动脉阻力（R）和肾血浆流量（RPF）以及上述生物标志物，这些青少年患有持续时间<10 年的 T1D 和无 T1D，且具有可比性的 BMI。
本研究纳入了 50 名 T1D 青少年（16.1±3.0 岁，HbA1c 8.6±1.2%）和 20 名无 T1D 且具有可比 BMI 的青少年（16.1±2.9 岁，HbA1c 5.2±0.2%）。与对照组相比，T1D 青少年的 GFR、RPF、R 和 P 明显更高（分别为 39%、33%、74%和 29%，所有 p<0.0001）。T1D 青少年的 RVR 和 R 也明显低于对照组（分别为 25%和 155%，均 p<0.0001）。YKL-40 和 KIM-1 浓度分别与 GFR（r：0.43，p=0.002；r：0.41，p=0.003）、RPF（r：0.29，p=0.08；r：0.34，p=0.04）、UACR（r：0.33，p=0.02；r：0.50，p=0.0002）和 P（r：0.45，p=0.006；r：0.52，p=0.001）呈正相关。
生物标志物 YKL-40 和 KIM-1 的浓度较高可能有助于确定 T1D 青少年肾小球内血液动力学功能障碍的风险。一份更清晰的图表摘要可在补充信息中查看。
