糖尿病肾病患者自身抗体检测的意义

Significance of autoantibody detection in patients of diabetic nephropathy

摘要:

目的??探讨糖尿病肾病（DN）患者抗肾小球基底膜抗体（anti-GBM?antibody） 、 抗心磷脂抗体（ACA） 、 尿酸（UA）和同型半胱氨酸（Hcy）检测的意义，为 DN 的诊断和治疗提供依据。方法??收集 174 例 2 型糖尿 病（T2DM）患者的血清， 依据肾小球滤过率（GFR）和尿蛋白 / 肌酐比值（ACR）分为单纯糖尿病组（A 组） 、 早期糖尿病肾病组（B 组） 、临床肾病组（C 组）和肾功能不全组（D 组） 。采用间接酶联免疫法检测 GBM 和 ACA，酶法检测 UA 和 Hcy。结果进行统计学分析。结果??B 组 UA、Hcy 和抗心磷脂抗体免疫球蛋白 M （ACA- IgM）水平高于 A 组， C 组和 D 组 UA、Hcy、GBM、抗心磷脂抗体免疫球蛋白 G （ACA-IgG）和抗心磷脂抗体 免疫球蛋白 A （ACA-IgA）水平高于 A 组， 差异有统计学意义（ P <0.05） ； C 组 UA 和 Hcy 水平高于 B 组， D 组 UA、Hcy、GBM 和 ACA-IgA 水平也高于 B 组，差异有统计学意义（ P <0.05） ； D 组 UA、Hcy 和 GBM 水平高 于 C 组，差异有统计学意义（ P <0.05） 。GBM、ACA-IgA、UA 和 Hcy 分别与 ACR 呈正相关（ r = 0.281、0.206、 0.411 和 0.492， P <0.05） ，ACA-IgG 和 ACA-IgM 与 ACR 无相关性。结论??血清 UA、Hcy 和 ACA-IgM 水平可提示早期肾损害， 血清 GBM、ACA、UA 和 Hcy 可作为 DN 疾病进程的监测指标。

Abstract:

Objective To investigate the significance of anti-glomerular basement membrane (anti-GBM), anti-cardiolipin antibodies (ACA), uric acid (UA) and homocysteine (Hcy) in patients with diabetic nephropathy (DN), and provide a basis for the diagnosis and treatment of DN. Methods Totally 174 patients with type 2 diabetes mellitus (T2DM) were divided into four groups according to estimated Glomerular Filtration Rate (GFR) and anurinary albumin to creatinine ratio (ACR): diabetic mellitus group (A group), early diabetic nephropathy group (B group), clinic diabetic nephropathy group (C group) and renal insufficiency group (D group). GBM and ACA were detected by indirect enzyme-linked immunosorbent assay, and UA and Hcy were detected by enzymatic method. The results were statistically analyzed. Results Compared with A group, UA, Hcy and anti-cardiolipin antibodies immune globulin M (ACA-IgM) levels in B group were increased, and levels of UA, Hcy, GBM, anti-cardiolipin antibodies immune globulin G (ACA-IgG) and anti-cardiolipin antibodies immune globulin A (ACA-IgA) in C group and D group were higher than those in A group, the differences were statistically significant (P < 0.05). Compared with B group, levels of UA and Hcy in C group were increased, and levels of UA, Hcy, GBM and ACA-IgA in D group were also increased, the differences were statistically significant (P < 0.05). Compared with C group, UA, Hcy and GBM levels in D group were increased, the differences were statistically significant (P < 0.05). ACR was negatively correlated with GBM, ACA-IgA, UA and Hcy (r = 0.281, 0.206, 0.411 and 0.492, P < 0.05), but not correlated with ACA-IgG and ACA-IgM. Conclusions Serum levels of UA, Hcy and ACA-IgM may indicate early renal damage. Serum GBM, ACA, UA and Hcy may be used as monitoring indicators for DN disease progression .