邱占军

（济南市第一人民医院，济南，250012.）

　【摘要】　目的　测定2型糖尿病患者尿转铁蛋白（Transferrin，TRF）、IV型胶原（type IV collagen，IV-C）、N-乙酰β-D-氨基葡萄糖苷酶（N-acetyl-beta-D-glucosaminidase，NAG）在糖尿病肾病早期诊断中的临床意义。方法　留取60例2型糖尿病患者和20例正常人24小时尿,测定尿TRF、IV-C、NAG、微量白蛋白排泄率（UAER）、尿肌酐(Cr)及其他相关生化指标。结果 反映肾小球功能损害的尿TRF、IV-C和反映肾小管功能损害的尿NAG在糖尿病尿微量白蛋白正常组及微量白蛋白尿组均较正常组显著升高，与UAER呈显著正相关。结论　尿TRF、IV-C、NAG在早期预测与筛选糖尿病肾病发生方面灵敏度高，糖尿病肾病早期肾小球受损的同时就存在肾小管功能损害,联合检测尿系列微量蛋白有助于早期、确切判断DN病变部位及损伤程度。山东中医药大学附属医院急诊科邱占军

【关键词】 糖尿病；糖尿病肾脏病变; 尿IV型胶原蛋白；尿转铁蛋白；尿N-乙酰-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 

糖尿病肾病(Diabetie nephropathy,DN)是糖尿病(Diabetes mellitus,DM)常见而难治的微血管并发症,是DM主要死因之一，早期诊断并积极治疗对阻止和延缓DN的发展有重要意义。我们对反映肾小球功能损害的尿转铁蛋白（Transferrin，TRF）、IV型胶原（type IV collagen，IV-C）和反映肾小管功能损害的N-乙酰β-D-氨基葡萄糖苷酶（N-acetyl-beta-D-glucosaminidase，NAG）等指标进行检测，探讨其对早期诊断DN的临床价值。

1 对象和方法

1.1 对象

1.1.1 2型糖尿病组 经我院内分泌科检查确诊的糖尿病患者60例，男性34例，女性26例。年龄53.54±11.14岁，病程0.1～16（5.77±4.42）年。均符合: (1)按照世界卫生组织标准(1999年)确诊为2型糖尿病;(2)无严重肝肾疾病、非糖尿病肾脏疾患、酮症酸中毒、低蛋白血症及尿路感染、甲状腺机能亢进病、心力衰竭、近期脑血管意外史;(3)无近期服用肾毒性药物、钙离子拮抗剂和血管紧张素转换酶抑制剂。据UAER测定结果,将其分为2个亚组：正常微量白蛋白尿（DM I)组，UAER