邱佔軍
（濟南市第一人民醫院，濟南，250012.）
【摘要】 目的 測定2型糖尿病患者尿轉鐵蛋白（Transferrin，TRF）、IV型膠原（type IV collagen，IV-C）、N-乙醯β-D-氨基葡萄糖苷酶（N-acetyl-beta-D-glucosaminidase，NAG）在糖尿病腎病早期診斷中的臨床意義。方法 留取60例2型糖尿病患者和20例正常人24小時尿,測定尿TRF、IV-C、NAG、微量白蛋白排洩率（UAER）、尿肌酐(Cr)及其他相關生化指標。結果 反映腎小球功能損害的尿TRF、IV-C和反映腎小管功能損害的尿NAG在糖尿病尿微量白蛋白正常組及微量白蛋白尿組均較正常組顯著升高，與UAER呈顯著正相關。結論 尿TRF、IV-C、NAG在早期預測與篩選糖尿病腎病發生方面靈敏度高，糖尿病腎病早期腎小球受損的同時就存在腎小管功能損害,聯合檢測尿系列微量蛋白有助於早期、確切判斷DN病變部位及損傷程度。山東中醫藥大學附屬醫院急診科邱佔軍
【關鍵詞】 糖尿病；糖尿病腎臟病變; 尿IV型膠原蛋白；尿轉鐵蛋白；尿N-乙醯-β-D氨基葡萄糖苷酶；尿微量白蛋白
The clinical significance of detection of urinary
Transferrin，type IV collagen ，N-acetyl-beta-D-glucosaminidase in the early diagnosis of early diabetic nephropathy. ZHANG Fen, QIU Zhan-jun
(The fifth pepole’s hospital of ji’nan, Ji’nan 250012,China)
【Abstract】 Objective To evaluate the clinical significance of detection of urinary Transferrin(TRF)，type IV collagen(IV-C) ，N-acetyl-beta-D-glucosaminidase(NAG) in the early diagnosis of type 2 diabetes. Methods To measure urinary IV-C，TRF，NAG，albumin excretory rate (UAER), and some other correlated biochemical indcies in 24-hour-urinary specimens from 60 type 2 diabetes and 20 normal controls.Results
Urinary TRF and IV-C which are the indices of functional lesion of glomerulus,and urinary NAG which is the indices of renal tubule are more elevated in the diabetes group than in the normal control group.There was a significant positive correlation between urinary TRF, IV-C, CERP, NAG and UAER. Conclusion Urinary TRF, IV-C, and NAG might be the indicators of the diagnosis of early diabetic nephropathy. The functional lesion of renal tubule has been existed when the function of glomerulus was damaged in early diabetic nephropathy.The union detection of urinary TRF, IV-C, and NAG is more sensetive and earlier method for the early diagnosis of DN,and can judge the diseased region and the degree of injury precisely.
【Key words】 Diabetes; Diabetic nephropathy; Urinary Transferrin; Urinary type IV collagen; Urinary N-acetyl-beta-D-glucosaminidase ; Urinary microalbumin
糖尿病腎病(Diabetie nephropathy,DN)是糖尿病(Diabetes mellitus,DM)常見而難治的微血管併發症,是DM主要死因之一，早期診斷並積極治療對阻止和延緩DN的發展有重要意義。我們對反映腎小球功能損害的尿轉鐵蛋白（Transferrin，TRF）、IV型膠原（type IV collagen，IV-C）和反映腎小管功能損害的N-乙醯β-D-氨基葡萄糖苷酶（N-acetyl-beta-D-glucosaminidase，NAG）等指標進行檢測，探討其對早期診斷DN的臨床價值。
1 物件和方法
1.1 物件
1.1.1 2型糖尿病組 經我院內分泌科檢查確診的糖尿病患者60例，男性34例，女性26例。年齡53.54±11.14歲，病程0.1～16（5.77±4.42）年。均符合: (1)按照世界衛生組織標準(1999年)確診為2型糖尿病;(2)無嚴重肝腎疾病、非糖尿病腎臟疾患、酮症酸中毒、低蛋白血癥及尿路感染、甲狀腺機能亢進病、心力衰竭、近期腦血管意外史;(3)無近期服用腎毒性藥物、鈣離子拮抗劑和血管緊張素轉換酶抑制劑。據UAER測定結果,將其分為2個亞組：正常微量白蛋白尿（DM I)組，UAER
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