CAJ | 학술논문

目的探讨尿p痕迹蛋白( beta-trace protein,βTP)检测在2型糖尿病(T2 DM)肾损伤中的诊断价值.方法临床确诊T2DM 174例,按照尿白蛋白(Alb)与肌酐(Cr)比值(Alb/Cr)将其分为糖尿病无肾损伤组(A组)和糖尿病肾损伤组(B组),另设健康对照组(C组)70名.采用胶乳增强散射免疫比浊法原理检测尿液βTP、α1微球蛋白( α1microglobulin,α1MG),免疫比浊法测定尿Alb,碱性苦味酸法测定Cr,测定结果以与Cr比值表示.比较各组尿βTP水平,并行ROC曲线分析,同时对尿βTP与α1MG及其他指标作相关分析.结果 B组尿βTP/ Cr中位数为9.1mg/gCr,显著高于A组的3.1mg/gCr和C组的2.0 mg/gCr,差异有统计学意义(H=45.5,P＜0.01).B组其他指标A(I)h/Cr、α1MG/Cr、血Cr(SCr)结果均高于A、C组(H值分别为110.9、38.3、11.4,P值均＜0.01).相关分析结果表明,尿βTP/Cr与尿α1MG/Cr呈显著正相关,相关系数为r =0.894(P ＜0.01),与SCr、糖化血红蛋白A1(HbAlC)、收缩压、病程呈正相关,r分别为0.367 (P＜ 0.05)、0.242(P＜0.05)、0.162(P ＜0.05)、0.251(P ＜0.05)；与舒张压、空腹血糖(FBG)、体重指数(BMI)无相关性.ROC曲线分析结果表明,尿βTP/Cr与α1MG/Cr曲线下面积分别为0.86 (95％CI 0.78 ～0.93)、0.76(95％ CI 0.67 ～0.85).尿βTP/Cr最佳判断水平为4.1mg/gCr,诊断敏感性为68.5％,特异性为89.8％；尿α1MG/Cr最佳判断水平为10.9 mg/gCr,诊断敏感性为59.7％,特异性为80.3％,两者差异有统计学意义(P＜0.05).结论尿βTP对T2DM肾损伤有诊断价值,可敏感地反映肾小管功能损伤,诊断价值优于尿α1MG,可作为评价肾小管损伤的一个新的生物标志物.
목적 탐토뇨p흔적단백( beta-trace protein,βTP)검측재2형당뇨병(T2 DM)신손상중적진단개치.방법 림상학진T2DM 174례,안조뇨백단백(Alb)여기항(Cr)비치(Alb/Cr)장기분위당뇨병무신손상조(A조)화당뇨병신손상조(B조),령설건강대조조(C조)70명.채용효유증강산사면역비탁법원리검측뇨액βTP、α1미구단백( α1microglobulin,α1MG),면역비탁법측정뇨Alb,감성고미산법측정Cr,측정결과이여Cr비치표시.비교각조뇨βTP수평,병행ROC곡선분석,동시대뇨βTP여α1MG급기타지표작상관분석.결과 B조뇨βTP/ Cr중위수위9.1mg/gCr,현저고우A조적3.1mg/gCr화C조적2.0 mg/gCr,차이유통계학의의(H=45.5,P＜0.01).B조기타지표A(I)h/Cr、α1MG/Cr、혈Cr(SCr)결과균고우A、C조(H치분별위110.9、38.3、11.4,P치균＜0.01).상관분석결과표명,뇨βTP/Cr여뇨α1MG/Cr정현저정상관,상관계수위r =0.894(P ＜0.01),여SCr、당화혈홍단백A1(HbAlC)、수축압、병정정정상관,r분별위0.367 (P＜ 0.05)、0.242(P＜0.05)、0.162(P ＜0.05)、0.251(P ＜0.05)；여서장압、공복혈당(FBG)、체중지수(BMI)무상관성.ROC곡선분석결과표명,뇨βTP/Cr여α1MG/Cr곡선하면적분별위0.86 (95％CI 0.78 ～0.93)、0.76(95％ CI 0.67 ～0.85).뇨βTP/Cr최가판단수평위4.1mg/gCr,진단민감성위68.5％,특이성위89.8％；뇨α1MG/Cr최가판단수평위10.9 mg/gCr,진단민감성위59.7％,특이성위80.3％,량자차이유통계학의의(P＜0.05).결론 뇨βTP대T2DM신손상유진단개치,가민감지반영신소관공능손상,진단개치우우뇨α1MG,가작위평개신소관손상적일개신적생물표지물.
Objective To study the potential use of the urinary beta-trace protein ( βTP) for diagnosis of type 2 diabetic renal injury.Methods 174 patients with type 2 diabetic mellitus (T2DM) were classified into 2 groups according to the ratio of urinary albumin to creatinine (Alb/Cr):diabetes without renal injury group (group A) and diabetes with renal injury group (group B).70 healthy subjects served as normal control group ( group C).The level of urinary βTP and αl microglobulin (α1MG) was measured by latex particle enhanced immunoturbidimetry assay.The urinary Alb and Cr were determined by nephelometry and Jaffe method respectively.The level of uriuary βTP among all groups was compared and ROC curve analysis was performed.The relevant analysis on urinary βTP,urinary α1MG and other related indexes was made.Results The median level of urinary βTP/Cr in group B was 9.1mg/g Cr,significantly higher than 3.1mg/g Cr of group A and 2.0mg/g Cr of group C.The difference had statistical significance ( H =45.5,P ＜ 0.01).The other indexes ( Alb/Cr,α1MG/Cr,SCr) were all higher in group B than in the other 2 groups ( H =110.9,38.3,11.4 respectively,P ＜0.01).The relevant analysis showed that urinary βTP/Cr was positively correlated with urinary α1MG/Cr (r =0.894,P ＜ 0.01),SCr (r =0.367,P ＜ 0.05 ),HbA(J) C ( r =0.242,P ＜ 0.05 ),systolic pressure ( r =0.162,P ＜0.05 ),and the course of the disease ( r =0.251,P ＜ 0.05 ).No correlation was found between urinary βTP/Cr and diastolic pressure,fasting blood glucose(FBG) or BMI.ROC curve analysis showed the area under the curve (AUC) was 0.86 (95％CI,0.78-0.93)for urinary βTP/Cr and 0.76 (95％ CI,0.67-0.85) for urinary α1MG/Cr.The best cut-off value of urinary βTP/Cr and α1MG/Cr was 4.1mg/g Cr vs 10.9mg/g Cr,the sensitivity was 68.5％ vs 59.7％,and the specificity was 89.8％ vs 80.3％.The difference had statistical significance (P ＜ 0.05).Conclusions Urinary βTP has better diagnostic value for type 2 diabetic patients with renal injury than urinary α1MG.It can sensitively reflect renal tubular injury and can be used as a novel available biomarker to evaluate the renal tubular injury in clinic.