CAJ | 학술논문

目的应用受试者工作特征曲线(ROC)评价尿Ⅳ型胶原和尿层粘连蛋白(LN)在糖尿病肾病(DN)监测中的临床价值.方法 143例病程大于5年的T2DM患者和103名正常对照用放射免疫法测定晨尿Ⅳ型胶原和尿LN水平,分析正常白蛋白尿的T2DM患者尿Ⅳ型胶原和尿LN的变化和ROC曲线下面积等.结果正常尿自蛋白组和微量尿白蛋白组的T2DM患者晨尿Ⅳ型胶原和尿LN水平均显著高于正常对照组(P＜0.05);尿Ⅳ型胶原＞18.9 ng/mL和尿LN＞130.33 ng/mL为正常参考范围上限;正常尿白蛋白的T2DM患者以晨尿Alb=16 mg/L为分界值时,尿Ⅳ型胶原曲线下面积(0.749)超过Alb/Cr面积(0.698)、尿Ⅳ型胶原和尿LN水平有显著变化(P＜0.05).结论病程大于5年.的正常尿白蛋白T2DM患者晨尿Ⅳ型胶原＞18.9 ng/ml或和尿LN＞130.33 ng/ml时,应高度怀疑早期DN.
목적 응용수시자공작특정곡선(ROC)평개뇨Ⅳ형효원화뇨층점련단백(LN)재당뇨병신병(DN)감측중적림상개치.방법 143례병정대우5년적T2DM환자화103명정상대조용방사면역법측정신뇨Ⅳ형효원화뇨LN수평,분석정상백단백뇨적T2DM환자뇨Ⅳ형효원화뇨LN적변화화ROC곡선하면적등.결과 정상뇨자단백조화미량뇨백단백조적T2DM환자신뇨Ⅳ형효원화뇨LN수평균현저고우정상대조조(P＜0.05);뇨Ⅳ형효원＞18.9 ng/mL화뇨LN＞130.33 ng/mL위정상삼고범위상한;정상뇨백단백적T2DM환자이신뇨Alb=16 mg/L위분계치시,뇨Ⅳ형효원곡선하면적(0.749)초과Alb/Cr면적(0.698)、뇨Ⅳ형효원화뇨LN수평유현저변화(P＜0.05).결론 병정대우5년.적정상뇨백단백T2DM환자신뇨Ⅳ형효원＞18.9 ng/ml혹화뇨LN＞130.33 ng/ml시,응고도부의조기DN.
Objective To evaluate the role of urinary type Ⅳ collagen and urinary laminin LN(LN) in screening diabetic nephropathy. Methods The urinary levels of Ⅳ and LN were measured by radioimmunoassay (RIA) in 143 cases with type 2 diabetes mellitus (T2DM) with the course over 5 years and in 103 normal controls (NC). The sensitivity and specificity of urinary Ⅳ and LN, UAlb/cre and urinary creatinine for diabetic nephropathy diagnosis were calculated and ROC curve was drawed. The area under curve of ROC of urinary Ⅳ and LN was compared with that of Alb/Cr in normal urinary albumin group of T2DM. Results The levels of Ⅳ and LN in group A(Alb/Cr<30mg/g) and group B(Alb/Cr 30-300 mg/g) were significantly higher than those in NC(P<0.05).The upper limit for the nomal referance of Ⅳ and LN were 18.9 ng/mL and 130.33 ng/mL respectively. In A group,AUCⅣ (0.749) was larger than AUCAlb/Cr(0.698) when Alb of 16 mg/L was a cut point. Conclusions The level of urinary Ⅳ and LN is a useful marker in screening DN.The urinary Ⅳ＞18.9 ng/ml and/or LN＞130.33 ng/mL in T2DM course beyond 5 years may be an indicator for DN.