“亚临床”2型糖尿病肾病患者尿血管紧张素原水平及相关因素分析  

Urinary angiotensinogen level and its risk factors in patients with ＂subclinical＂ diabetic nephropathy

作　　者：杨笑云 常宝成[1] 单春艳[1] 徐延光[1] 张袆[1] 韩菲[1] 王靖宇[1] 许杰[1] 郑妙艳[1] 任慧珠[1] 杨菊红[1] 

机构地区：[1]天津医科大学代谢病医院糖尿病肾病科,卫生部激素与发育重点实验室,300070

出　　处：《中华内分泌代谢杂志》2015年第5期395-399,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金项目（81173428,81373864,81200612）

摘　　要：目的评价“亚临床”2型糖尿病肾病患者尿血管紧张素原（UAGT）水平的变化及相关因素。方法（1）80例无高血压且未服用血管紧张素转换酶抑制剂（ACEI）或血管紧张素Ⅱ受体阻断剂（ARB）类药物的2型糖尿病患者。按照尿蛋白水平及肾小球滤过率分为正常蛋白尿正常滤过组（即正常对照组）、正常蛋白尿高滤过组（即“亚临床”糖尿病肾病组）、微量蛋白尿组（早期糖尿病肾病组），比较各组间UAGT水平；（2）同时将患者根据肾小管受损的严重程度进行分组，比较各组间的UAGT水平并分析其相关因素；（3）另入选20例处于早期糖尿病肾病阶段且应用ACEI或ARB类药物的2型糖尿病患者．与处于同一阶段未应用ACEI或ARB类药物患者比较UAGT水平差异。结果与正常对照组患者相比，“亚临床”糖尿病。肾病组患者的UAGT明显下降[（1．47±0．11对1．59±0．11）ng／ml，P〈0．05]，但进展至早期糖尿病。肾病UAGT明显升高[（1．62±0．15）ng／ml，P〈0．05]；随肾小管损伤程度的逐渐加重，UAGT呈逐渐升高趋势；多元线性回归分析显示UAGT与估算的肾小球滤过率呈负相关（P〈0．05），与视黄醇结合蛋白呈正相关（P〈0．05）；早期糖尿病肾病患者，应用ACEI或ARB类药物可明显降低UAGT水平[（1．43±0．16对1．62±0．15）ng／ml，P〈0．05]。结论肾脏局部UAGT在“亚临床”糖尿病肾病及早期糖尿病肾病阶段存在先下降而后升高的动态变化过程，可能参与了2型糖尿病肾小球及肾小管损伤的发生发展，肾素一血管紧张素系统抑制剂可以降低微量白蛋白尿患者的UAGT，延缓肾脏病变进展。Objective To evaluate the level and related factors of urinary angiotensinogen in patients with ＂subclinical＂ diabetic nephropathy. Methods （ 1 ） A total of 80 type 2 diabetic patients without angiotensin-eonverting enzyme inhibitor （ACEI） or angiotensin lI receptor blocker（ ARB ） treatment and hypertension were divided into 3 groups according to 24-hour urinary albuminuria and estimated glomerular filtration rate （eGFR） ： normoalbuminuria with normal glomerular filtration rate group [ urinary microalbuminuria （ UMA ） 〈 30 mg/24 h, 90 ≤ eGFR 〈 120 ml·min^-1·（ 1.73 m^2 ） -1 , NC group, n=28], normoalbuminuria with glomerular hyperfiltration group[ UMA〈30 mg/24 h, eGFR≥120 ml·min^-1· （ 1.73 m^2） -1 , SDN group, n=36], mieroalbuminuria group[30 h≤UMA〈300 mg/24 h, 90 ≤ eGFR〈 120 ml· min^-1·（ 1.73 m2 ） -1, EDN group, n = 161- The levels of urinary angiotensinogen among various groups were compared. （ 2 ） The levels of urine retinol binding protein （ RBP）, N-acetyl-β-D-glucosaminadase, α-galactosidase, and β2-microglobubin were used to evaluate the renal tubular function. Then all the patients were divided into 4 groups according to the degree of renal tubular injury ; the urinary angiotensinogen was compared and the independent related factors were analyzed. （ 3 ） 20 type 2 diabetic patients with microalbuminuria and ACEI or ARB treatment were also enrolled in this study. The level of urinary angiotensinogen was compared between patients with and without ACEI or ARB treatment. Results Compared with NC group, the level of urinary angiotensinogen in the SDN group was lowered [ （ 1.47 - 0.11 vs 1.59± 0.11 ） ng/ml,P〈0.05 ], but was raised in the EDN group [ （ 1.62 ± 0.15 ） ng/ml, P〈0.05 ]. With the aggravation of renal tubular injury, the level of urinary angiotensinogen was increased. Multiple regression analysis showed that urinary angiotensinogen was positively correlated with RBP（P〈0. 05 ） and negatively correlated with eG

关 键 词：亚临床 糖尿病.肾病 尿血管紧张素原 肾小管 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]