BETA-2-GLYCOPROTEIN-1 (APOLIPOPROTEIN-H) EXCRETION AND RENAL TUBULAR MALFUNCTION IN DIABETIC-PATIENTS WITHOUT CLINICAL PROTEINURIA
BETA-2-GLYCOPROTEIN-1 (APOLIPOPROTEIN-H) EXCRETION AND RENAL TUBULAR MALFUNCTION IN DIABETIC-PATIENTS WITHOUT CLINICAL PROTEINURIA
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DOI：
10.1136/jcp.46.5.465
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发表时间：
1993-05-01
影响因子：
3.4
通讯作者：
SANSOM, PA
中科院分区：
文献类型：
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作者：
LAPSLEY, M;FLYNN, FV;SANSOM, PA
目的：比较无临床蛋白尿的糖尿病患者尿β 2-糖蛋白-1与其他两种早期肾小管病变标志物的排泄。和N-乙酰-β-D-氨基葡萄糖苷酶在90名已知的糖尿病患者中进行了测量，这些患者的蛋白尿试剂条试验为阴性。在43例尿白蛋白排泄在参考范围内的患者中，23例（53%）尿N-乙酰-β-D-氨基葡萄糖苷酶活性升高，5例（12%）β 2-糖蛋白-1排泄增加，5例（12%）视黄醇结合蛋白丢失增加。在47例白蛋白排泄量为0.9-7.9 mg/mmol肌酐的患者中，42例（89%）尿N-乙酰-β-D-氨基葡萄糖苷酶升高，23例（49%）β 2-糖蛋白-1分泌增加，16例（34%）视黄醇结合蛋白排泄增加。这些肾小管缺陷标志物的排泄很少超过参考上限的2.5倍，并且在具有相似白蛋白排泄的胰岛素依赖型和非胰岛素依赖型患者中的结果之间的差异很小且不显著。（a）尿β 2-糖蛋白-1的测定可能是比视黄醇结合蛋白的测量更灵敏的检测肾小管蛋白重吸收受损的测试;（B）N-乙酰基-β-D-氨基葡萄糖苷酶测定可在蛋白重吸收保持正常时检测肾小管损伤;和（c）在没有肾小球功能障碍证据的情况下可能存在肾小管功能受损。
Aim-To compare the urinary excretion of beta2-glycoprotein-1 with that of two other markers of early tubular disorder in diabetic patients without clinical proteinuria.Methods-The urinary excretion of retinol binding protein, beta2-glycoprotein-1, and N-acetyl-beta-D-glucosaminidase was measured in 90 known diabetic patients who had a negative reagent strip test for proteinuria.Results-Among 43 patients with urinary albumin excretion within the reference range, 23 (53%) had raised urinary N-acetyl-beta-D-glucosaminidase activity, five (12%) increased excretion of beta2-glycoprotein-1, and five (12%) increased loss of retinol binding protein. Among 47 patients with an albumin excretion of 0.9-7.9 mg/mmol creatinine, 42 (89%) had increased urinary N-acetyl-beta-D-glucosaminidase, 23 (49%) an increased output of beta2-glycoprotein-1, and 16 (34%) a raised excretion of retinol binding protein. The excretion of these markers of tubular defects seldom exceeded two and a half times the upper reference limit and the differences between the findings in the insulin dependent and non-insulin dependent patients with similar albumin excretion were small and insignificant.Conclusions-In diabetic patients with a negative dipstick test for proteinuria: (a) assay of urinary beta2-glycoprotein-1 may be a more sensitive test for the detection of impaired tubular reabsorption of protein than measurement of retinol-binding protein; (b) assay of N-acetyl-beta-D-glucosaminidase can detect tubular injury at a time when protein reabsorption remains normal; and (c) impaired renal tubular function may be present in the absence of evidence of glomerular malfunction.