糖化白蛋白、糖化血红蛋白与2型糖尿病早期肾损伤的关系  

Analysis of the glycated albumin and glycated haemoglobin in early diabetic nephropathy in patients with type 2 diabetes

作　　者：杨浩[1] 孔德宝[1] 付靖瑜 柯俊[2] 高琨[3] YANG Hao;KONG De-bao;FU Jing-yu;KE Jun;GAO Kun(Department of Public Health,Huangshi Central Hospital（Affiliated Hospital of Hubei Polytechnic University）,Edong Healthcare Group,Huangshi 435000,Hubei,Chin)

机构地区：[1]鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)医学检验科,湖北黄石435000 [2]鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)公共卫生科,湖北黄石435000 [3]鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)骨科,湖北黄石435000

出　　处：《广东医学》2018年第13期1989-1992,共4页Guangdong Medical Journal

基　　金：湖北省自然科学基金资助项目(编号:2015CFB627);黄石市科技计划项目(编号:2013A077-4)

摘　　要：目的分析糖化白蛋白(GA)、糖化血红蛋白(Hb A1C)与2型糖尿病患者(T2DM)肾损伤的关系。方法将96例T2DM患者按是否合并糖尿病肾病(DN)分为早期DN组(n=54)与非DN组(n=42),选取同期体检的40例正常健康人作为对照组。各组均抽取清晨空腹静脉血、收集晨尿标本,测定GA、Hb A1C、尿微量白蛋白(U-m ALB)、尿液转铁蛋白(U-TRF)、尿液α1微球蛋白(U-α1MG)、尿液IGg(UIg G)、血清肌酐(Cr)、血清尿素(UREA)等指标,分析GA及Hb A1C与糖尿病并发肾损伤的相关性。结果非DN组、早期DN组GA、Hb A1C均高于对照组(P<0.05);早期DN组GA、Hb A1C水平高于非DN组(P<0.05)。Logistic回归分析显示GA、Hb A1C、U-m ALB、U-TRF是早期DN的独立影响因素(P<0.05),且Hb A1C的相关度(OR值=1.551,P<0.05)高于GA(OR值=1.224,P<0.05)。通过ROC曲线分析,GA和Hb A1C对糖尿病患者DN诊断的最佳切点为18.5%(敏感度0.854,特异度0.827)和7.7%(敏感度0.976,特异度0.613),而当GA与Hb A1C联合检测时,则具有更高的ROC曲线下面积(0.976)。结论 GA、Hb A1C、U-m ALB、UTRF等参数均与糖尿病早期肾损伤有密切关联,且GA与Hb A1C均为影响早期DN进展的独立危险因素,而当GA与Hb A1C联合检测时,其对糖尿病早期肾损伤的预测和诊断具有重要的参考价值。Objective To investigate the correlations between glycated albumin（ GA）,glycated haemoglobin（ Hb A1 C） and diabetic nephropathy（ DN） in patients with type 2 diabetes（ T2 DM）. Methods Ninety-six cases of T2 DM from November 2016 to September 2017 were divided into early DN group（ n = 54） and non-DN group（ n = 42）,as 40 healthy people at the same time were selected as control group. The morning fasting venous blood and urine samples of all subjects were obtained to measure glycated albumin（ GA）,glycosylated hemoglobin（ Hb A1 C）,urinary microalbumin（ U-m ALB）,urinary transferrin（ U-TRF）,urinary alpha 1 microglobulin（ U-tient,urinary Ig G（ U-Ig G）,serum creatinine（ CREA）,serum urea（ UREA） and other indicators. The correlations between GA,Hb A1 Cand diabetic nephropathy were analyzed. Results The levels of GA and Hb A1 Cin non-DN group and early DN group were significantly higher than those in control group（ P〈0. 05）. The levels of GA and Hb A1 Cin DN group were significantly higher than those in non-DN group（ P〈0. 05）. Logistic regression analysis showed that GA,Hb A1 C,u-m ALB and U-TRF were independent influencing factors of DN（ P〈0. 05）,and the correlation degree of Hb A1 C（ OR = 1. 551,P〈0. 05）was higher than GA（ OR = 1. 224,P〈0. 05）. Through the analysis of ROC curve,the optimal cut point for DN of GA and Hb A1 Cwere 18. 5%（ sensitivity 0. 854,specificity 0. 827） and 7. 7%（ sensitivity 0. 976,specificity 0. 613）,respectively. The area under the ROC curve using combination of GA and Hb A1 Cwas 0. 976,which was higher than using them alone. Conclusion GA,Hb A1 C,u-m ALB and U-TRF are closely correlated to diabetic renal injury. GA and Hb A1 Care independent risk factors for the progression of DN. The combination of Hb A1 Cand GA provide an important value for the prediction and diagnosis of early kidney injury of patients with type 2 diabetes.

关 键 词：糖化白蛋白 糖化血红蛋白 2型糖尿病 糖尿病肾病 

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