1 型糖尿病儿童和青少年的尿液中中性粒细胞明胶酶相关脂褐素浓度与健康儿童的尿液中中性粒细胞明胶酶相关脂褐素浓度是否不同?

Bernardica Valent Morić, Ivan Šamija, Lavinia La Grasta Sabolić, Adriana Unić, Marijana Miler
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摘要

导言:糖尿病肾病(DKD)是1型糖尿病(T1DM)的主要微血管并发症之一。一些研究表明,肾小管成分的变化出现在肾小球病变之前,因此提出了糖尿病肾小管病变的概念,并将尿液中性粒细胞明胶酶相关脂质钙蛋白(uNGAL)作为 DKD 的潜在标志物。这一概念并未在所有研究中得到证实:在中位年龄为 15 岁、糖尿病病程超过一年的 198 名 T1DM 患者中,测定白蛋白/肌酐比值(ACR),并测量定点尿样中的尿中性粒细胞凝胶酶相关脂联素(uNGAL)。此外,还收集了 100 名年龄相仿的健康儿童作为对照组的尿样,以测定白蛋白/肌酐比值(ACR)和尿蛋白总胆固醇(uNGAL):结果:T1DM患儿和健康受试者的uNGAL浓度或uNGAL/肌酐无明显差异(6.9 (2.8-20.1) ng/mL vs 7.9 (2.9-21.0) ng/mL,P = 0.969 和 6.8 (2.2-18.4) ng/mg vs 6.5 (1.9-13.4) ng/mg,P = 0.448),或者白蛋白尿 A2 和白蛋白尿 A1 的 T1DM 受试者之间(P = 0.573 和 0.595)。在 T1DM 患者中,168 人(85%)的尿蛋白总胆固醇浓度正常,30 人(15%)的尿蛋白总胆固醇浓度高于 30.9 纳克/毫升的定义临界值。与uNGAL正常的患者相比,uNGAL升高的患者在体重指数(BMI)、HbA1c和糖尿病持续时间方面没有差异:我们发现,T1DM 儿童和健康受试者之间,以及白蛋白尿 A2 和白蛋白尿 A1 T1DM 受试者之间,uNGAL 浓度或 uNGAL/肌酐均无明显差异。因此,不建议将uNGAL作为检测儿童和青少年糖尿病肾病的单一指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is the urinary neutrophil gelatinase-associated lipocalin concentration in children and adolescents with type 1 diabetes mellitus different from that in healthy children?

Introduction: Diabetic kidney disease (DKD) is one of the major microvascular complications of type 1 diabetes mellitus (T1DM). Some studies suggest that changes of renal tubular components emerge before the glomerular lesions thus introducing the concept of diabetic tubulopathy with urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a potential marker of DKD. This concept was not confirmed in all studies.

Materials and methods: In 198 T1DM patients with median age 15 years and diabetes duration over one year, an albumin/creatinine ratio (ACR) was determined and uNGAL measured in spot urine sample. Urine samples for ACR and uNGAL were also collected in the control group of 100 healthy children of similar age.

Results: There was no significant difference in uNGAL concentration or uNGAL/creatinine between T1DM children and healthy subjects (6.9 (2.8-20.1) ng/mL vs 7.9 (2.9-21.0) ng/mL, P = 0.969 and 6.8 (2.2-18.4) ng/mg vs 6.5 (1.9-13.4) ng/mg, P = 0.448, respectively) or between T1DM subjects with albuminuria A2 and albuminuria A1 (P = 0.573 and 0.595, respectively). Among T1DM patients 168 (85%) had normal uNGAL concentrations, while in 30 (15%) patients uNGAL was above the defined cut-off value of 30.9 ng/mL. There was no difference in BMI, HbA1c and diabetes duration between patients with elevated uNGAL compared to those with normal uNGAL.

Conclusions: We found no significant difference in uNGAL concentration or uNGAL/creatinine between T1DM children and healthy subjects or between albuminuria A2 and albuminuria A1 T1DM subjects. Therefore, uNGAL should not be recommended as a single marker for detecting diabetic kidney disease in children and adolescents.

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