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目的 探讨应用尿 α1 -微球蛋白 (α1 - MG)早期诊断老年糖尿病肾病肾小管间质损害。方法 用放免法和 SPECT等技术测定 96例老年糖尿病及 34例正常老年人尿α1 - MG、2 4 h尿微量白蛋白排量 (UAE)及肾小球滤过率等肾小球功能。结果 老年糖尿病患者尿 α1 - MG高于正常 ;在正常白蛋白尿阶段的老年糖尿病其尿 α1 - MG已明显高于正常 ,以后随病情进展加重 ,从微量白蛋白尿到临床蛋白尿 ,尿α1 - MG渐升高 ,反映肾小管间质损害逐渐加重 ;随尿α1 - MG升高 ,肾小球滤过率降低 ,UAE渐升高 ,肾小球功能损伤渐加重。结论 老年糖尿病早期已有肾小管间质损害 ,尿 α1 - MG水平能敏感反映肾小管间质损害的程度。
Objective To investigate the early diagnosis of tubulointerstitial damage in senile diabetic nephropathy with urine α1 - microglobulin (α1 - MG). Methods Urinary α1 - MG, 24 h urine microalbuminuria (UAE) and glomerular filtration rate (GFR) were measured in 96 elderly patients with diabetes mellitus and 34 normal controls by radioimmunoassay and SPECT. Results Urine α1 - MG in elderly diabetic patients was higher than normal. Urinary α1 - MG in elderly diabetic patients with normal albuminuria stage was significantly higher than normal. Later, with the progression of the disease aggravating, microalbuminuria to clinical proteinuria, urine α1 - MG gradually increased, reflecting the gradual increase of tubulointerstitial damage; with the increase of urinary α1 - MG, glomerular filtration rate decreased, UAE gradually increased, glomerular function gradually increased. Conclusion Tubulointerstitial lesions have been found in the early stage of diabetes in old people. Urine α1 - MG level can reflect the degree of tubulointerstitial injury.