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首页> 外文期刊>American Journal of Kidney Diseases: The official journal of the National Kidney Foundation >Early urinary markers of diabetic kidney disease: a nested case-control study from the Diabetes Control and Complications Trial (DCCT).
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Early urinary markers of diabetic kidney disease: a nested case-control study from the Diabetes Control and Complications Trial (DCCT).

机译：糖尿病肾脏疾病的早期尿液指标：来自糖尿病控制和并发症试验（DCCT）的嵌套病例对照研究。

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摘要

BACKGROUND: Urinary markers were tested as predictors of macroalbuminuria or microalbuminuria in patients with type 1 diabetes. STUDY DESIGN: Nested case-control of participants in the Diabetes Control and Complications Trial (DCCT). SETTING & PARTICIPANTS: 87 cases of microalbuminuria were matched to 174 controls in a 1:2 ratio, while 4 cases were matched to 4 controls in a 1:1 ratio, resulting in 91 cases and 178 controls for microalbuminuria. 55 cases of macroalbuminuria were matched to 110 controls in a 1:2 ratio. Controls were free of micro-/macroalbuminuria when their matching case first developed micro-/macroalbuminuria. PREDICTORS: Urinary N-acetyl-beta-d-glucosaminidase (NAG), pentosidine, advanced glycation end product (AGE) fluorescence, and albumin excretion rate (AER). OUTCOMES: Incident microalbuminuria (2 consecutive annual AERs > 40 but < or = 300 mg/d) or macroalbuminuria (AER > 300 mg/d). MEASUREMENTS: Stored urine samples from DCCT entry and 1-9 years later when macro- or microalbuminuria occurred were measured for the lysosomal enzyme NAG and the AGE pentosidine and AGE fluorescence. AER and adjustor variables were obtained from the DCCT. RESULTS: Submicroalbuminuric AER levels at baseline independently predicted microalbuminuria (adjusted OR, 1.83; P < 0.001) and macroalbuminuria (adjusted OR, 1.82; P < 0.001). Baseline NAG excretion independently predicted macroalbuminuria (adjusted OR, 2.26; P < 0.001) and microalbuminuria (adjusted OR, 1.86; P < 0.001). Baseline pentosidine excretion predicted macroalbuminuria (adjusted OR, 6.89; P = 0.002). Baseline AGE fluorescence predicted microalbuminuria (adjusted OR, 1.68; P = 0.02). However, adjusted for NAG excretion, pentosidine excretion and AGE fluorescence lost the predictive association with macroalbuminuria and microalbuminuria, respectively. LIMITATIONS: Use of angiotensin-converting enzyme inhibitors was not directly ascertained, although their use was proscribed during the DCCT. CONCLUSIONS: Early in type 1 diabetes, repeated measurements of AER and urinary NAG excretion may identify individuals susceptible to future diabetic nephropathy. Combining the 2 markers may yield a better predictive model than either one alone. Renal tubule stress may be more severe, reflecting abnormal renal tubule processing of AGE-modified proteins, in individuals susceptible to diabetic nephropathy.
机译：背景：尿液标志物被测试为1型糖尿病患者中巨蛋白尿或微量白蛋白尿的预测指标。研究设计：糖尿病控制和并发症试验（DCCT）中参与者的嵌套病例控制。地点和参与者：以1：2的比例将87例微量白蛋白尿与174个对照相匹配，以1：1的比例将4例病例与4个对照相匹配，从而导致91例和178个微白蛋白尿对照。 55例大白蛋白尿与110例对照以1：2的比例匹配。当对照病例首次出现微/大白蛋白尿时，对照没有微/大白蛋白尿。预测者：尿N-乙酰基-β-d-氨基葡萄糖苷酶（NAG），戊糖苷，晚期糖基化终产物（AGE）荧光和白蛋白排泄率（AER）。结果：偶发性微量白蛋白尿（连续2年AERs> 40，但≤300 mg / d）或大白蛋白尿（AER> 300 mg / d）。测量：从DCCT入口和1-9年后发生大白蛋白尿或微白蛋白尿时，对所储存的尿液样品进行溶酶体酶NAG，AGE戊糖苷和AGE荧光检测。 AER和调节器变量是从DCCT获得的。结果：基线下的微量白蛋白尿AER水平独立预测微白蛋白尿（校正OR，1.83; P <0.001）和大白蛋白尿（校正OR，1.82; P <0.001）。基线NAG排泄独立预测巨蛋白尿（校正OR，2.26; P <0.001）和微量白蛋白尿（校正OR，1.86; P <0.001）。基线戊糖苷排泄预测为巨蛋白尿（校正OR，6.89; P = 0.002）。基线AGE荧光预测微量白蛋白尿（校正OR，1.68; P = 0.02）。但是，对NAG排泄进行调整后，戊糖苷排泄和AGE荧光分别丧失了与大白蛋白尿和微白蛋白尿的预测联系。局限性：尽管在DCCT期间禁止使用血管紧张素转化酶抑制剂，但并未直接确定其用途。结论：在1型糖尿病的早期，对AER和尿NAG排泄物的重复测量可能会识别出将来可能患有糖尿病肾病的个体。组合这两种标志物可能比单独使用任一标志物产生更好的预测模型。在易患糖尿病性肾病的个体中，肾小管应力可能更为严重，反映了AGE修饰蛋白的异常肾小管加工。

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