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目的观察糖尿病肾病患者血浆及尿尾加压素Ⅱ(UⅡ)水平与肾小管损伤的相关性。方法正常对照组19例,2型糖尿病患者52例,根据尿白蛋白排泄率(UAER)分为三组:正常白蛋白尿组(NA组,n=17):UAER<20μg/min;微量白蛋白尿组(MA组,n=21):UAER20～200μg/min;糖尿病肾病大量白蛋白尿组(DN组,n=14):UAER>200μg/min。采用放射免疫分析法检测血浆、尿UⅡ含量,肾小管损伤标志物选用中性粒细胞明胶酶相关脂钙蛋白(NGAL)和视黄醇结合蛋白4(RBP4),采用ELISA方法检测其尿NGAL以及RBP4水平,尿中上述物质浓度用尿肌酐浓度校正。结果 DN组尿UⅡ水平较健康对照组、NA组升高[(281.5±144.3)ng/gcreatinine vs.(153.0±66.1)ng/gcreatinine,(160.0±50.0)ng/gcreatinine,P<0.05]。DN组血UⅡ水平较正常对照组升高[(65.5±17.7)pg/mlvs.(40.1±13.3)pg/ml,P<0.05]。直线相关回归分析显示尿UⅡ水平与尿lnNGAL及lnRBP4水平呈正相关(r=0.853、0.569,P=0.000),与eGFR负相关(r=-0.435,P=0.008);但血UⅡ水平和尿UⅡ水平并不相关。多元回归分析显示,尿NGAL与尿UⅡ水平呈独立正相关(β=1.073,P=0.000)。结论在糖尿病肾病患者中,血、尿UⅡ水平均升高,两者并无相关性;尿中UⅡ水平与糖尿病患者肾小管损伤标志物独立相关。肾内UⅡ水平独立于全身血循环水平,作用靶点可能在肾小管和间质。
Objective To investigate the correlation between plasma and urotensin Ⅱ (UⅡ) levels and renal tubular injury in patients with diabetic nephropathy. Methods Nineteen cases of normal control group and 52 cases of type 2 diabetic patients were divided into three groups according to urinary albumin excretion rate (UAER): normal albuminuria group (NA group, n = 17): UAER <20μg / min; Proteinuria group (MA group, n = 21): UAER 20 ~ 200μg / min; diabetic nephropathy massive albuminuria group (DN group, n = 14): UAER> 200μg / min. Radioimmunoassay was used to detect plasma and urinary UII levels. Neutrophil gelatinase-associated calpain (NGAL) and retinol binding protein 4 (RBP4) were used as markers of renal tubular injury. Urinary NGAL was detected by ELISA. RBP4 levels, urinary concentrations of these substances with urine creatinine concentration correction. Results Urinary UⅡ level in DN group was significantly higher than that in healthy control group and NA group [(281.5 ± 144.3) ng / g creatinine vs (153.0 ± 66.1) ng / g creatinine, (160.0 ± 50.0) ng / g creatinine, respectively. Blood UⅡ level in DN group was significantly higher than that in control group [(65.5 ± 17.7) pg / ml vs (40.1 ± 13.3) pg / ml, P <0.05]. Linear regression analysis showed that urine UⅡ level was positively correlated with urinary lnNGAL and lnRBP4 levels (r = 0.853, 0.569, P = 0.000) and negatively correlated with eGFR (r = -0.435, P = 0.008) The level is not relevant. Multivariate regression analysis showed that there was a positive correlation between urinary NGAL and urine UⅡ (β = 1.073, P = 0.000). Conclusions In patients with diabetic nephropathy, UⅡ levels in blood and urine are elevated, but there is no correlation between them. UⅡ levels in urine are independently associated with renal tubular injury markers in diabetic patients. Intrarenal UII levels independent of the systemic blood circulation level, the role of the target may be in the tubules and stroma.