糖尿病肾病早期诊断指标的研究进展
Research Progress on Early Diagnostic Indicators of Diabetic Nephropathy
DOI: 10.12677/ACM.2022.12111502, PDF,    科研立项经费支持
作者: 秦 凤：青海大学附属医院，青海 西宁
关键词: 糖尿病肾病；诊断指标；研究进展；Diabetes Nephropathy； Diagnostic Indicators； Research Progress
摘要: 糖尿病肾病(Diabetic Nephropathy, DN)是糖尿病患者最常见的微血管并发症。随着我国老龄化速度加快和生活方式的改变，导致我国2型糖尿病(type 2 diabetes mellitus, T2DM)的发病人群逐年快速上升，而糖尿病肾病的患者数量也在大幅度提升，已经成为严重的社会公共卫生问题。糖尿病肾病发展快、隐匿性强，早期缺乏特异性的诊断指标，这造成了部分患者在确诊为糖尿病时就已经伴有糖尿病肾病，甚至肾损伤已经不可逆转。提高早期糖尿病肾病的临床筛查能力，对于预防和延缓糖尿病肾病的发生、发展具有切实、有效的意义。
Abstract: Diabetes nephropathy (DN) is the most common microvascular complication in diabetes patients. With the acceleration of aging in China and the change of lifestyle, the incidence of type 2 diabetes (T2DM) in China has increased rapidly year by year, and the number of patients with diabetes nephropathy has also increased significantly, which has become a serious social and public health problem. Diabetes nephropathy develops rapidly, has strong concealment, and lacks specific diag-nostic indicators at the early stage, which causes some patients to have diabetes nephropathy when diagnosed with diabetes, and even kidney damage has become irreversible. Improving the clinical screening ability of early diabetes nephropathy has practical and effective significance for prevent-ing and delaying the occurrence and development of diabetes nephropathy.
文章引用：秦凤. 糖尿病肾病早期诊断指标的研究进展[J]. 临床医学进展, 2022, 12(11): 10423-10431. https://doi.org/10.12677/ACM.2022.12111502

参考文献

[1] Fioretto, P., Bruseghin, M., Berto, I., et al. (2006) Renal Protection in Diabetes: Role of Glycemic Control. Journal of the American Society of Nephrology, 17, S86-S89. [Google Scholar] [CrossRef] 
[2] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013版) [J]. 中国糖尿病杂志, 2014, 22(8): 21.
[3] 赵京, 王晓阳, 肖静, 等. 尿液血管内皮生长因子作为早期糖尿病肾病诊断的生物学标志物[J]. 肾脏病与透析肾移植杂志, 2016, 25(3): 220-224.
[4] Zhang, L., Long, J., Jiang, W., et al. (2016) Trends in Chronic Kidney Disease in China. The New Eng-land Journal of Medicine, 375, 905-906. [Google Scholar] [CrossRef] 
[5] Adamski, J. (2012) Ge-nome-Wide Association Studies with Metabolomics. Genome Medicine, 4, Article No. 34. [Google Scholar] [CrossRef] [PubMed]
[6] Afkarian, M., Sachs, M.C., Kestenbaum, B., et al. (2013) Kidney Disease and Increased Mortality Risk in Type 2 Diabetes. Journal of the American Society of Nephrology, 24, 302-308. [Google Scholar] [CrossRef] 
[7] 林伟卓. 糖尿病早期肾损伤诊断中尿糖、尿微量白蛋白联合检验的临床分析[J]. 当代医学, 2014, 20(338): 85-86.
[8] 胡俊, 谭红, 王冬梅. 四种尿微量蛋白测定在糖尿病肾病早期诊断的价值[J]. 实用医技杂志, 2007, 14(33): 4557-4558.
[9] 秦昊, 田浩明, 梁荩忠. 2型糖尿病患者血浆和尿纤维连接蛋白与尿转铁蛋白测定的临床意义[J]. 华西医大学报2002, 33(3): 421-423.
[10] Tofik, R., Torffvit, O., Rippe, B., et al. (2009) Increased Urine IgM Exretion Predicts Cardiovascular Events in Patients with Type Diabetes Nephropathy. BMC Medicine, 7, Article No. 39. [Google Scholar] [CrossRef] [PubMed]
[11] 闫璞, 张宁, 李同侠, 杜华. 24 h尿微量白蛋白定量与尿微量白蛋白/肌酐比值在糖尿病肾脏病中的相关性研究[J]. 中国中西医结合肾病杂志, 2020, 21(5): 413-415.
[12] 乔玉峰, 庞东梓, 等. 糖尿病肾病早期诊断指标研究进展[J]. 国外医学泌尿系统分册, 2005, 25(5): 670.
[13] Akinlade, K.S., Arinola, O.G., Salimonu, L.S., et al. (2004) Circulating Immune Complexes, Immunoglobulin Classes (IgG, IgA and IgM) and Complement Components (C3c, C4 and FactorB) in Dia-betic Nigerians. West African Journal of Medicine, 23, 253-255. [Google Scholar] [CrossRef] [PubMed]
[14] Bouvet, B.R., Paparella, C.V., Arriaga, S.M., et al. (2014) Evalua-tion of Urinary N-acetyl-beta-D-glucosaminidase as a Marker of Early Renal Damage in Patients with Type 2 Diabetes Mellitus. Arquivos Brasileiros de Endocrinologia e Metabologia, 58, 798-801. [Google Scholar] [CrossRef] [PubMed]
[15] Ouchi, M., Oba, K., Motoyama, M., et al. (2014) Postprandial Glycemic Control Conditions in Relation to Urinary N-acetyl-beta-β-glucosaminidase in Patients with Type 2 Diabetes Mellitus without Low Glomerular Filtration Rate. Diabetes Technology & Therapeutics, 16, 41-47. [Google Scholar] [CrossRef] [PubMed]
[16] 孙林, 曾丽霞, 王斌, 等. 白细胞介素6反义RNA对肾小球系膜细胞的影响[J]. 中华肾脏病杂志, 1997, 13(1): 6.
[17] Mantovani, A., Bussolino, F. and Intrano, M. (1997) Cytokine Regulation of Endothdialcell Function from Molecular Level to the Bedside. Immunology Today, 18, 231-240. [Google Scholar] [CrossRef] 
[18] 聂丽华, 曾昭良, 潘东. 白细胞介素因子与不同分型糖尿病肾病之间的关系探讨[J]. 贵州医药, 2017, 41(8): 830-832.
[19] 何煜, 廖婷婷, 黄龙, 等. 硫辛酸对早期2型糖尿病肾病微炎症状态影响的研究[J]. 贵阳中医学院学报, 2013, 35(5): 82-85.
[20] 卜聪亚, 周玉杰, 赵迎新, 等. 高龄糖尿病合并心房颤动患者高敏C反应蛋白和同型半胱氨酸与颈动脉硬化关系的研究[J]. 中华老年心脑血管病杂志, 2013, 15(9): 903-905.
[21] Zhang, C., Xiao, C., Wang, P., et al. (2004) The Alteration of Th1/Th2/Th17/Treg Paradigm in Patients with Type 2 Diabetes Mellitus: Relationship with Diabetic Nephropathy. Human Immunology, 75, 289-296. [Google Scholar] [CrossRef] [PubMed]
[22] Yu, R., Bo, H., Villani, V., et al. (2016) The Inhibitory Effect of Rapamycin on Toll Like Receptor 4 and Interleukin 17 in the Early Stage of Rat Diabetic Nephropathy. Kidney and Blood Pressure Research, 41, 55-69. [Google Scholar] [CrossRef] [PubMed]
[23] 於文丽, 吴小燕, 张伶俐, 姚涛. 白细胞介素-17在肾组织的表达与糖尿病肾病关系探讨[J]. 中国中西医结合肾病杂志, 2010, 11(11): 958-960.
[24] 崔海英, 任洪涛, 姜涛, 等. 2型糖尿病肾病患者血清TNF-α、IL-18、ADPN水平测定[J]. 中国实验诊断学, 2012, 16(9): 1658-1660.
[25] 唐灵, 梁志清, 刘树娇, 等. 不同分期糖尿病肾病患者血清 IL-18、CRP水平的变化及意义[J]. 山东医药, 2011, 51(37): 1-3.
[26] 欧阳清, 梁志清, 刘健, 等. 白细胞介素-18、胱抑素C在2型糖尿病肾病早期诊断的意义[J]. 中国实验诊断学, 2011, 15(4): 730-731.
[27] Akagi, Y., Isaka, Y., Arai, M., et al. (1996) Inhibition of TGF-beta Expression by Antisense Oligonucleotides Suppressed Extracellular Matrix Accumulation in Experimental Glomerulonephritis. Kid-ney International, 50, 148-155. [Google Scholar] [CrossRef] [PubMed]
[28] Pena, R.A., Jerdan, J.A. and Glaser, B.M. (1994) Effects of TGF-beta and TGF-beta Neutralizing Antibodies Fibroblast Induced Collagen Gel Contraction: Implications for Proliferative Vitre-oretinopathy. Investigative Ophthalmology & Visual Science, 35, 2804-2808.
[29] Hills, C.E. and Squires, P.E. (2011) The Role of TGF-beta and Epithelial-To Mesenchymal Transition in Diabetic Nephropathy. Cytokine and Growth Factor Reviews, 22, 131-139. [Google Scholar] [CrossRef] [PubMed]
[30] Sam, R., Wanna, L., Gudehithlu, K., et al. (2006) Glomerular Epithelial Cells Transform to Myofibroblasts Early but Not Late Removal of TGF-β1 Reverses Transformation. Translational Research, 148, 142-148. [Google Scholar] [CrossRef] [PubMed]
[31] Brennan, E.P., Morine, M.J., Walsh, D.W., et al. (2012) Nextgener-ation Sequencing Identifies TGF-betal-Associated Gene Expression Profiles in Renal Epithelial Cells Reiterated in Hu-man Diabetic Nephropathy. Biochimica et Biophysica Acta, 1822, 589-599. [Google Scholar] [CrossRef] [PubMed]
[32] Chaturbhuj, G.U. and Akamanchi, K.G. (2011) Copper Cata-lyzed Gomberg-Buchmann-Hey Reaction Using Aryldiazonium Tosylate. Tetrahedron Letters: The International Jour-nal for the Rapid Publication of Preliminary Communications in Organic Chemistry, 52, 4950-4953. [Google Scholar] [CrossRef] 
[33] Souissi, M., Feki, M., Mourali, S., et al. (2006) Homocysteinemia and Coronary Artery Disease: A Case Control Study in a Tunisian Population. Archives des Maladies du Coeur et des Vaisseaux, 99, 781-785.
[34] Becker, A., Henry, R.M., Kostense, P.J., et al. (2003) Plasma Homocysteine and S-adenosylmethionine in Erythrocytes as Determinants of Carotid Intima-Media Thickness: Different Effects in Diabetic and Non-Diabetic Individual. Atherosclerosis, 169, 323-330. [Google Scholar] [CrossRef] 
[35] 杨秀莲, 马丽娟, 温晓燕. 同型半胱氨酸检测在糖尿病肾病中的临床意义[J]. 宁夏医学杂志, 2010, 32(1): 67-68.
[36] Kassab, A., Ajmi, T., Issaoui, M., et al. (2008) Homocysteine Enhances LDL Fatty Acid Peroxidation, Promoting Microalbuminuria in Type 2 Diabetes. Annals of Clinical Biochemistry, 45, 476-480. [Google Scholar] [CrossRef] [PubMed]
[37] 罗长青, 王玉梅, 邓安国, 等. 测定血清CystatinC浓度判断肾小球滤过率的临床意[J]. 临床内科杂志, 2003, 20(3): 154.
[38] 孙红, 陈莎, 段艺, 等. 血清胱抑素C在儿童肾脏疾病中的应用研究[J]. 微循环学杂志, 2005, 15(4): 31-32.
[39] 杨芳. 胱抑素C在糖尿病肾病早期诊断中的作用[J]. 医学信息, 2009, 22(12): 232-232.
[40] 皮婧静, 梁柱, 佘宁兰, 等. 胱抑素C对糖尿病肾病早期诊断的临床价值探讨[J]. 中华临床医师杂志(电子版), 2012, 6(23): 7796-7798.
[41] 陈晖, 朱清, 邵凤民. 血清胱抑素C在糖尿病肾病早期诊断中的临床意义[J]. 中国综合临床, 2009, 25(7): 710-711.
[42] Coil, E., Botey, A., Alvarez, L., et al. (2000) Serum Cystatin C as a New Marker for Non Invasive Estimation of Glomerular Tiltration Rate and as a Marker for Early Impairment. American Journal of Kidney Diseases, 36, 29-34. [Google Scholar] [CrossRef] [PubMed]
[43] Dharnidharka, V.R., Kwon, C. and Stevens, G. (2002) Serum Cystatin C Is Superior to Serum Creatinine as a Marker of Kidney Function: A Meta-Analysis. American Journal of Kidney Dis-eases, 40, 221-226. [Google Scholar] [CrossRef] [PubMed]
[44] 秦明明, 朱其铮, 张育琴, 张洪旭. 胱抑素C及同型半胱氨酸在糖尿病肾病中的检测及其临床意义[J]. 齐齐哈尔医学院学报, 2016, 37(28): 3497-3499.
[45] Tervaert, T.W., Mooyaart, A.L., Amann, K., et al. (2010) Pathologic Classification of Diabetic Nephropathy. Journal of the American Society of Nephrology, 21, 556-563. [Google Scholar] [CrossRef] 
[46] 刘洋, 程庆砾. 糖尿病早期肾小管间质病变的研究进展[J]. 中华医学杂志, 2017, 97(34): 2710.
[47] Lizicarova, D., Krahulec, B., Hirnerova, E., Gaspar, L. and Celecova, Z. (2014) Risk Factors in Diabetic Nephropathy Progression at Present. Bratislavské Lekárske Listy, 115, 517-521. [Google Scholar] [CrossRef] 
[48] 王瑞英, 姚敏, 王绵, 等. 2型糖尿病模型大鼠肾小管上皮细胞中TGF-β1的表达与肾功能的关系[J]. 中国老年学杂志, 2005, 25(5): 549-551.
[49] 陈婧. 糖尿病肾病早期诊断及肾活检指征[J]. 肾脏与透析移植杂志, 2011, 20(4): 349-350.
[50] 蒋振兴, 王毓, 丁玖乐, 等. 血氧水平依赖MRI评估糖尿病肾病肾功能损伤的研究[J]. 磁共振成像, 2015, 6(7): 524-528.
[51] 彭国平, 王江, 张鹏. 糖尿病肾病的彩色多普勒超声研究进展[J]. 湖北中医药大学学报, 2013, 15(4): 67-69.
[52] 郑向红, 宁宁, 等. 99Tcm-DTPA肾动态显像及血清胱抑素Ｃ检测在糖尿病肾病早期诊断中的临床应用[J]. 陕西医学杂志, 2013, 42(7): 786-788.
[53] 徐梅华, 蔡克银. 2型糖尿病患者踝臂指数与糖尿病肾病的关系研究[J]. 实用预防医学, 2012, 19(9): 1418-1420.
[54] 中华医学会糖尿病学分会微血管并发症学组. 最新糖尿病肾病防治专家共识(2014版) [J]. 中华糖尿病杂志, 2014, 6(11): 792-801.
[55] Molitch, M.E., Steffes, M.W., Cleary, P.A., et al. (1993) Base-line Analysis of Renal Function in the Diabetes Control and Complications Trial. Kidney International, 43, 668-674. [Google Scholar] [CrossRef] [PubMed]
[56] Parving, H.H., Hommel, E., Mathiesen, E., et al. (1988) Prevalence of Mi-croalbuminuria, Arterial Hypertension, Retinopathy and Neuropathy in Insulin-Dependent Diabetic Patients. British Medical Journal (Clinical Research ed.), 29, 156-163. [Google Scholar] [CrossRef] [PubMed]
[57] Cecile, D., Beryl, V.L. and Francoise, V.K. (1996) Clinical Correlates of Advanced Retinopathy in Type 2 Diabetic Patients. Journal of Clinical Epidemiology, 49, 679-685. [Google Scholar] [CrossRef] 
[58] Parving, H.H., Gall, M.A., Skott, P., Jorgensen, H.E., Lokkegaard, H., Jorgensen, F., Nielsen, B. and Larsen, S. (1992) Prevalence and Causes of Albuminuria in Noninsulin-Dependent Diabetic Patients. Kidney International, 41, 758-762. [Google Scholar] [CrossRef] [PubMed]
[59] Chavers, B.M., Mauer, S.M., Ramsay, R.C., et al. (1994) Relationship between Retinal and Glomerular Lesions in IDDM Patients. Diabetes, 43, 441-446. [Google Scholar] [CrossRef] [PubMed]

为你推荐