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目的：探讨2 型糖尿病（DM）患者的肾小管功能改变，分析其相关因素。方法：将64 例2 型DM 患者根据尿微量白蛋白量分为3 组：正常蛋白尿组（＜30mg/24h）21 例、微量白蛋白尿组（30~300mg/24h）20 例和临床蛋白尿组（＞300mg/24h）23 例，测定各组尿β2 微球蛋白（U-β2MG）和尿渗透压（U-OSM）。探讨年龄、DM 病程、24h 尿白蛋白量、糖化血红蛋白、血压、血脂水平与肾小管功能损害的关系。结果：2 型DM 患者均有不同程度的尿β2MG 增高及尿渗透压减低，在正常蛋白尿组即有4 例尿β2-MG 和7 例尿OSM 存在异常；方差分析显示，随尿白蛋白量的增高，尿β2MG 逐步增高，尿渗透压逐步减低，三组间差异有统计学意义（F=26.123 和13.889, P 均＜0.01），任两组比较差异均有统计学意义（P 均＜0.05）。线性回归显示，尿β2MG 及尿OSM 改变与 DM 病程、尿白蛋白（U-ALB）、收缩压（SBP）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、低密度脂蛋白（LDL-C）独立有关。结论：2 型DM 肾脏损害并非仅累及肾小球，在尿微量白蛋白出现之前即可出现肾小管功能异常。联合检测24h 尿白蛋白量、尿β2-MG、尿OSM 有助于全面评估2 型糖尿病患者的肾脏损害情况。严格控制血糖，尽早纠正代谢紊乱对肾小管功能有保护作用。

英文摘要:

Objective: To observe the changes of renal tubular function in patients with type 2 diabetes mellitus（DM）and investigate the factors influencing renal fuctions. Methods: A total of 64 patients with DM were divided into three groups according levels of 24 hours urinary albumin:Normal urinary albumin group (urinary albumin<30mg per 24h), Urinary micro-albumin group(urinary albumin in 30-300mg per 24h),Clinical albuminuria group ( urinary albumin >300 per 24h), to campare the differences of Urine-β2-microglobulin and urinary osmolality in each groups,and to observe the relation of the level of 24 hours urinary albumin,duration of diabetes,age and metabolic index including HbA1c,blood pressure and lipid with these parameters. Results: Urine-β2-microglobulin increased but urinary osmolality decreased in all patients. In the normal urinary albumin group,there were 4 cases of abnormal urinaryβ2MG and 7 cases of abnormal urinary OSM.Variance analysis showed that with the increased amount of urinary albumin urinary β2MG gradually increased, urinary osmolality gradually reduced. The difference among the three groups was significant (F = 26.123 and 13.889, P all <0.01). Any difference between the two groups were statistically significant (P all <0.05). Linear regression showed that the changes of urinary β2MG and urinary OSM independently related to DM duration, urinary albumin (U-ALB), systolic blood pressure (SBP), glycosylated hemoglobin (HbA1c), total cholesterol (TC), and low density lipoprotein (LDL-C ). Conclusion: Type 2 DM kidney damage was not confined to glomerular, renal tubular dysfunction can occur before the appearance of urinary albumin. The combined detection of 24h urinary albumin, urinaryβ2-MG and urinary OSM contribute to complete assessment the kidney damage of patients with type 2 diabetes, These findings suggested that good glycemic control and metabolism disturbance correction had a protective effect in renal tubular function.

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