CAJ | 학술논문

目的观察糖尿病肾病患者血浆及尿尾加压素Ⅱ（UⅡ）水平与肾小管损伤的相关性。方法正常对照组19例，2型糖尿病患者52例，根据尿白蛋白排泄率（ UAER）分为三组：正常白蛋白尿组（NA组，n＝17）：UAER＜20μg/min；微量白蛋白尿组（MA组，n＝21）：UAER 20～200μg/min；糖尿病肾病大量白蛋白尿组（DN组，n＝14）：UAER＞200μg/min。采用放射免疫分析法检测血浆、尿UⅡ含量，肾小管损伤标志物选用中性粒细胞明胶酶相关脂钙蛋白（NGAL）和视黄醇结合蛋白4（RBP4），采用ELISA方法检测其尿NGAL以及RBP4水平，尿中上述物质浓度用尿肌酐浓度校正。结果 DN组尿UⅡ水平较健康对照组、NA组升高[（281.5±144.3）ng/g creatinine vs．（153.0±66.1）ng/g creatinine，（160.0±50.0）ng/g creatinine， P＜0.05]。 DN组血UⅡ水平较正常对照组升高[（65.5±17.7）pg/ml vs．（40.1±13.3）pg/ml，P＜0.05]。直线相关回归分析显示尿UⅡ水平与尿lnNGAL及lnRBP4水平呈正相关（ r＝0.853、0.569， P＝0.000），与eGFR负相关（ r＝-0.435，P＝0.008）；但血UⅡ水平和尿UⅡ水平并不相关。多元回归分析显示，尿NGAL与尿UⅡ水平呈独立正相关（β＝1.073，P＝0.000）。结论在糖尿病肾病患者中，血、尿UⅡ水平均升高，两者并无相关性；尿中UⅡ水平与糖尿病患者肾小管损伤标志物独立相关。肾内UⅡ水平独立于全身血循环水平，作用靶点可能在肾小管和间质。
목적관찰당뇨병신병환자혈장급뇨미가압소Ⅱ（UⅡ）수평여신소관손상적상관성。방법정상대조조19례，2형당뇨병환자52례，근거뇨백단백배설솔（ UAER）분위삼조：정상백단백뇨조（NA조，n＝17）：UAER＜20μg/min；미량백단백뇨조（MA조，n＝21）：UAER 20～200μg/min；당뇨병신병대량백단백뇨조（DN조，n＝14）：UAER＞200μg/min。채용방사면역분석법검측혈장、뇨UⅡ함량，신소관손상표지물선용중성립세포명효매상관지개단백（NGAL）화시황순결합단백4（RBP4），채용ELISA방법검측기뇨NGAL이급RBP4수평，뇨중상술물질농도용뇨기항농도교정。결과 DN조뇨UⅡ수평교건강대조조、NA조승고[（281.5±144.3）ng/g creatinine vs．（153.0±66.1）ng/g creatinine，（160.0±50.0）ng/g creatinine， P＜0.05]。 DN조혈UⅡ수평교정상대조조승고[（65.5±17.7）pg/ml vs．（40.1±13.3）pg/ml，P＜0.05]。직선상관회귀분석현시뇨UⅡ수평여뇨lnNGAL급lnRBP4수평정정상관（ r＝0.853、0.569， P＝0.000），여eGFR부상관（ r＝-0.435，P＝0.008）；단혈UⅡ수평화뇨UⅡ수평병불상관。다원회귀분석현시，뇨NGAL여뇨UⅡ수평정독립정상관（β＝1.073，P＝0.000）。결론재당뇨병신병환자중，혈、뇨UⅡ수평균승고，량자병무상관성；뇨중UⅡ수평여당뇨병환자신소관손상표지물독립상관。신내UⅡ수평독립우전신혈순배수평，작용파점가능재신소관화간질。
Objective To observe the changes of plasma and urine urotensinⅡ( UⅡ) levels in patients with diabetes, and to illustrate the relationship between UⅡand renal tubules injury in type 2 diabetes and diabetic nephropathy patients .Methods 19 healthy control subjects and 52 type 2 diatetes patients were collected ,diabetes patients were divided into three groups according to urinary album in excretion rate ( UAER):NA group with UAER<20 μg/min(n=17),MA group with UAER:20-200 μg/min(n=21)and DN group with UAER >200 μg/min(n=14).Plasma and urine UⅡconcentrations were measured by radioimmunoassay .Urinary NGAL and RBP4 were tested by ELISA and calibrated by urinary creatitine concentration .Results Patients in DN group had significantly higher urinary UⅡlevels than healthy control subjects group and NA group [(281.5 ±144.3)ng/g creatinine vs.(153.0 ± 66.1)ng/g creatinine,(160.0 ±50.0)ng/g creatinine,P<0.05].Plasma UⅡ level was elevated in DN group compared with healthy volunteers[(65.5 ±17.7)pg/ml vs.(40.1 ±13.3)pg/ml,P<0.05].There were positive correlations between urinary UⅡand urinary lnNGAL , lnRBP4 ( r =0.853 , 0.569 , P =0.000 ) .There was no correlation between urinary UⅡand plasma UⅡ.Multiple regression analysis showed that urinary NGAL level was independently positively correlated with urinary UⅡconcentration (β=1.073 ,P=0.000 ) .Conclusions In patients with diabetic nephropathy,both urinary and plasma UⅡlevels were elevated.However,urinary UⅡdid not correlate with plasma UⅡ.Urinary UⅡmight be involved in the renal tubules injury .Intra-renal UⅡmight be independent of the circulation level whose target was located in renal tubule interstitium .