糖尿病患者临床肾病前肾功能改变的研究  

Kidney Function Changes Prior to the Onset of Clinical Nephropathy in Diabetic Patients

作　　者：王洪[1] 陈家伟[1] 张忠邦[1] 蒋须勤[1] 张家明[2] 

机构地区：[1]南京医学院第一附属医院内分泌科 [2]南京医学院生化科

出　　处：《南京医学院学报》1992年第3期232-237,共6页

摘　　要：研究了67例临床肾病前糖尿病患者肾功能改变。根据24h 尿白蛋白排泄量(UAE)将患者分为 UAE 正常组(NAU)、UAE 可疑升高组(SAU)、微量白蛋白尿组(MAU)、临界糖尿病肾病组(BDN)和早期糖尿病肾病组(EDN)。新提出的 SAU 特点是具有肾小球高滤过(平均 Ccr 最高、血β_2-MG 最低),且在该组 UAE 与血β_2-MG 之间呈现显著负相关,而与 Ccr 之间呈现显著正相关。随着 UAE 水平的升高(即进入 BDN 或 EDN 阶段),血β_2-MG平均水平相应地升高,而 Ccr 平均水平则相应地降低,同时血压也逐渐升高,UAE 与平均动脉压(MAP)之间呈现显著正相关。配对资料研究显示 EDN 平均收缩压和舒张压及血β_2-MG 和血 Cr 水平均显著高于 NAU。提示随着 UAE 水平的升高,肾脏由高功能期进入功能减退期,且SAU 期可能反映更早阶段的肾脏受累;血压升高是 EDN 阶段的重要标志。本研究还显示 UAE升高除与肾小球对白蛋白滤过增加有关外,可能也与肾小管对白蛋白的重吸收能力下降有关。Renal function changes were studied in 67 cases of diabetic patients without clinical diabetic nephropathy.The patients were classified as normoalbuminuric group(NAU),suspicious microalbuminuric group(SAU)and microalbuminuric group(MAU)which was subdivided into borderline diabetic nephropathy group(BDN)and early diabetic nephropathy group(EDN)according to their 24hr urinary albumin excretion(UAE).The distinguishing feature of SAU was the glomerular hyperfiltration(The mean of Ccr is high at its maximum as the mean of plasma β_2-MG was low at its minimum),and there was a significant negative correlation between UAE andeplasma β_2-MG along with a significant positive correlation between UAE and Ccr in this group; Furthermore,the increase of UAE levels(ie.development into BDN or EDN)was subsequently followed by the elevated mean of plasma β_2-MG levels with the mean of Ccr reduced correspondingly;contemporaneo sly,their blood pressure also gradually elevated.The UAE was significantly and positively related to the mean arterial pressure(MAP).In the paired study of NIDDM,the means of both systolic and diastolic blood pressure,plasma β_2-MG level and plasma Cr level in EDN group were significantly higher than those of NAU as a control. It indicated that diabetic renal involvment developed from renal hyperfunction stage into the functionally reduced stage with the elevation of UAE level,SAU might reflect even an earlier stage of diabetic renal involvement and raised blood pressure as an important mark of EDN stage,which might be the result of EDN rather than the cause of it,might be an important risk factor to enhance renal damage.This study also showed that elevated UAE was not only related to the increase of glomerular-filtrated albumin but also related to the reduction of ability of renal tubular reabsorption of albumin.

关 键 词：糖尿病 肾功能 肾病 诊断 

分 类 号：R587.1[医药卫生—内分泌]