Kahaly G, Hansen C, Otto E, Förster G, Beyer J, Hommel G
Departments of Endocrinology/Metabolism, Gutenberg University Hospital, Mainz, Germany.
Exp Clin Endocrinol Diabetes. 1997;105(3):145-51. doi: 10.1055/s-0029-1211743.
Alterations in the metabolism of glycosaminoglycans (GAG) may play a role in the pathogenesis of diabetic-associated microangiopathy. Consequently, the relationship between diabetic nephropathy and retinopathy and urinary GAG distribution was assessed in 96 IDDM patients in comparison to 103 healthy controls. GAG concentration in 24h urine samples was determined by precipitation with cetylpyridinium chloride and potassium acetate in ethanol followed by a colorimetric test with carbazole. A marked difference (P = 0.0008) in urinary GAG excretion between patients (24.3 +/- 1.5 mg/24 h, mean +/- SEM) and controls (16.2 +/- 0.75 mg/24 h) could be detected. In patients with IDDM of longer duration, GAG excretion was increased (< or = 10 yr: 20.8 +/- 2.1 vs > 10 yr: 27.4 +/- 2.1 mg/24 h; P = 0.03). Furthermore, IDDM patients with class 4 nephropathy and retinopathy exhibited a markedly higher GAG excretion compared to those without nephropathy (33.1 +/- 3.0 vs 22.6 +/- 1.7 mg/24 h, P = 0.005) or retinopathy (29.7 +/- 2.8 vs 21.2 +/- 1.7 mg/24 h, P = 0.009). An increased urinary GAG concentration was detected in IDDM patients with albuminuria (> 300 mg/24 h: 29.9 +/- 3.3 vs < 30 mg/24 h: 23.0 +/- 1.7 mg/24 h; P = 0.048), proteinuria (> 0.5 g/24 h: 30.3 +/- 3.7 vs < 0.05 g/24 h: 22.7 +/- 1.6 mg/24 h) and in patients with augmented serum creatinine in comparison to those with normal values (> 0.12 mg/L: 34.9 +/- 2.3 vs < 0.12 mg/L: 22.4 +/- 1.6 mg/24 h; P = 0.01). The results demonstrate a close relationship renal GAG excretion and the presence of microangiopathy in IDDM patients.
糖胺聚糖（GAG）代谢的改变可能在糖尿病相关微血管病变的发病机制中起作用。因此，与103名健康对照者相比，对96名胰岛素依赖型糖尿病（IDDM）患者的糖尿病肾病、视网膜病变与尿GAG分布之间的关系进行了评估。通过在乙醇中用十六烷基吡啶氯化物和乙酸钾沉淀，然后用咔唑进行比色试验，测定24小时尿液样本中的GAG浓度。可以检测到患者（24.3±1.5毫克/24小时，平均值±标准误）和对照者（16.2±0.75毫克/24小时）之间尿GAG排泄有显著差异（P = 0.0008）。在病程较长的IDDM患者中，GAG排泄增加（≤10年：20.8±2.1与>10年：27.4±2.1毫克/24小时；P = 0.03）。此外，与无肾病（33.1±3.0与22.6±1.7毫克/24小时，P = 0.005）或无视网膜病变（29.7±2.8与21.2±1.7毫克/24小时，P = 0.009）的患者相比，患有4级肾病和视网膜病变的IDDM患者表现出明显更高的GAG排泄。在有蛋白尿（>300毫克/24小时：29.9±3.3与<30毫克/24小时：23.0±1.7毫克/24小时；P = 0.048）、蛋白尿（>0.5克/24小时：30.3±3.7与<0.05克/24小时：22.7±1.6毫克/24小时）的IDDM患者以及血清肌酐升高的患者中，与正常值的患者相比（>0.12毫克/升：34.9±2.3与<0.12毫克/升：22.4±1.6毫克/24小时；P = 0.01），检测到尿GAG浓度升高。结果表明，IDDM患者肾GAG排泄与微血管病变的存在密切相关。
