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目的探讨AGEs类物质在不同程度的糖尿病慢性肾脏疾病(CKD)患者体内的蓄积情况。方法选取糖尿病患者259例,根据24hUAlb分为单纯糖尿病(DM,UAlb<30mg/24h)组58例、微量蛋白尿(CKD1,UAlb 30~300mg/24h)组62例、临床蛋白尿(CKD2,UAlb>300mg/24h)组53例、肾功能失代偿(CKD3,Scr 133~442μmol/L)组51例及尿毒症(U,Scr>442μmol/L,持续血液透析治疗)组35例。另选同期体检健康者51名作为对照(NC)组。检测各组血清中AGEs、低分子量AGEs(LMWAGEs)和游离戊糖苷酶(FP)的荧光强度。结果 CKD1组血清AGEs荧光强度高于DM组和NC组,且DM组高于NC组[(14.94±3.07)vs(10.80±2.35)vs(6.23±1.25)U/mg],CKD3组高于CKD2组[(51.50±10.33)vs(15.57±3.20)U/mg](P<0.05);DM组血清LMW-AGEs荧光强度与CKD1组,CKD2组与CKD3组比较,差异无统计学意义(P>0.05),其余各组两两比较差异均有统计学意义(P<0.05),且U组最高;U组血清FP荧光强度高于其他各组(P=0.001),而其余各组两两比较,差异无统计学意义。结论测定血清AGEs和LMW-AGEs的水平可对早期肾损害的诊断、肾损害程度的分析及终末期肾病的评价提供帮助,FP主要适用于终末期肾病的评价,而对早期肾损害不敏感。
Objective To investigate the accumulation of AGEs in patients with chronic kidney disease (CKD) with varying degrees of diabetes. Methods A total of 259 diabetic patients were enrolled in this study. According to 24hUAlb, 58 patients with DM (UAlb <30mg / 24h), 62 patients with CKD (UAb 30 ~ 300mg / 24h), CKD2 (N = 35), and renal failure (CKD3, Scr 133 ~ 442μmol / L) and uremia (U, Scr> 442μmol / L, continuous hemodialysis treatment) In the same period, 51 healthy people were selected as the control (NC) group. The fluorescence intensity of AGEs, LMWAGEs and free pentosidase (FP) in serum of each group was detected. Results The fluorescence intensity of serum AGEs in CKD1 group was higher than that in DM group and NC group, and higher in DM group than in NC group [(14.94 ± 3.07) vs (10.80 ± 2.35) vs (6.23 ± 1.25) U / mg] (51.50 ± 10.33 vs 15.57 ± 3.20 U / mg, P <0.05). There was no significant difference in serum LMW-AGEs fluorescence intensity between DM group and CKD1 group, CKD2 group and CKD3 group (P> 0.05). The remaining groups showed significant difference between every two groups (P <0.05), and the highest in U group. The serum FP fluorescence intensity of U group was higher than that of other groups (P = 0.001) ,The difference was not statistically significant. Conclusion The determination of the serum levels of AGEs and LMW-AGEs can be helpful in the diagnosis of early renal damage, the degree of renal damage and the assessment of end-stage renal disease. FP is mainly suitable for the evaluation of end-stage renal disease, but not for the early renal damage.