CAJ | 학술논문

目的探讨糖尿病肾病（DN）老年患者尿液mindin含量与肾功能损伤程度的关系。方法2012年10月至2013年6月本院住院的2型糖尿病（T2DM ）患者作为研究对象，按24h尿白蛋白定量（24h‐UAE）水平将其分为3组：正常蛋白尿组（A组）：24h‐UAE＜30 mg者70例；微量蛋白尿组（B组）：30≤24h‐UAE＜300 mg者50例；大量蛋白尿组（C组）：24h‐UAE＞300 mg者48例。同期年龄、性别匹配的健康体检者50例作为对照组。测定尿液mindin、血及尿肌酐、血尿素氮、胱抑素C、空腹及餐后血糖、糖化血红蛋白（HbA1c）、空腹C肽等临床指标，并估算肾小球滤过率（eGFR）。结果 T2DM 患者C组、B组和A组尿mindin含量高于对照组[分别为435（227～905）、327（179～406）、163（117～223）、91（50～120） L ? ng／mL ?μmol；F＝31．037，P＜0．05]，随着24h‐UAE的升高，其含量亦呈升高趋势（ r＝0．461，P＜0．05）。相关性分析显示尿mindin与尿素氮、血肌酐、胱抑素C、血糖、24h‐UAE、病程呈正相关，而与eGFR呈负相关。logistic回归分析显示尿液mindin含量、舒张压和空腹血糖水平是T2DM患者肾损伤的独立影响因素。结论尿液mindin可反映糖尿病肾功能损伤，并与肾功能损伤的程度相关，尿液mindin的检测对DM患者早期诊断DN具有较好的临床应用价值。
목적탐토당뇨병신병（DN）노년환자뇨액mindin함량여신공능손상정도적관계。방법2012년10월지2013년6월본원주원적2형당뇨병（T2DM ）환자작위연구대상，안24h뇨백단백정량（24h‐UAE）수평장기분위3조：정상단백뇨조（A조）：24h‐UAE＜30 mg자70례；미량단백뇨조（B조）：30≤24h‐UAE＜300 mg자50례；대량단백뇨조（C조）：24h‐UAE＞300 mg자48례。동기년령、성별필배적건강체검자50례작위대조조。측정뇨액mindin、혈급뇨기항、혈뇨소담、광억소C、공복급찬후혈당、당화혈홍단백（HbA1c）、공복C태등림상지표，병고산신소구려과솔（eGFR）。결과 T2DM 환자C조、B조화A조뇨mindin함량고우대조조[분별위435（227～905）、327（179～406）、163（117～223）、91（50～120） L ? ng／mL ?μmol；F＝31．037，P＜0．05]，수착24h‐UAE적승고，기함량역정승고추세（ r＝0．461，P＜0．05）。상관성분석현시뇨mindin여뇨소담、혈기항、광억소C、혈당、24h‐UAE、병정정정상관，이여eGFR정부상관。logistic회귀분석현시뇨액mindin함량、서장압화공복혈당수평시T2DM환자신손상적독립영향인소。결론뇨액mindin가반영당뇨병신공능손상，병여신공능손상적정도상관，뇨액mindin적검측대DM환자조기진단DN구유교호적림상응용개치。
[Objective]To evaluate the level of urinary mindin in elder patients with type 2 diabetes melli‐tus (T2DM ) and analyze its association with renal injury .[Methods]From October 2012 to June 2013 ,a total of 168 T2DM patients were recruited and divided into three groups of normoalbuminuria (urinary albumin <30 mg/24h ,n=70) ,microalbuminuria (30 ≤ urinary albumin <300 mg/24h ,n=50) and macroalbuminuria (u‐rinary albumin >300 mg/24h ,n =48) .And 50 age and gender‐matched subjects were selected into normal control group .The levels of urinary mindin ,blood & urinary creatinine ,serum urea nitrogen ,cystatin C , blood glucose ,glycated hemoglobin and C‐peptide ,etc .were measured .[Results]The levels of urinary mindin were significantly higher in the macroalbuminuria ,microalbuminuria and normoalbuminuria groups than those of control group [435(227~905) ,327(179~406) ,163(117~223) & 91(50~120) L?ng/mL? μmol re‐spectively ;F=31 .037 ,P <0 .05] .With rising 24 h‐UAE ,the level of urinary mindin also showed a trend of increase (r=0 .461 ,P<0 .05) .The urinary level of mindin was positively correlated with urea nitrogen ,cre‐atinine ,cystatin C ,blood glucose ,24 h‐urinary albumin and course of T2DM while negatively correlated with estimated glomerular filtration rate .Logistic regression analysis showed that urinary mindin ,diastolic blood pressure and fasting blood‐glucose were independent influencing factors of renal injury in T2DM .[Conclusion]Urinary mindin is probably closely correlated with diabetic nephropathy and participates in the progress of dia‐betic nephropathy .And it may serve as a potential marker for an early diagnosis of diabetic nephropathy .