【摘要】 目的 探讨2型糖尿病(T2DM)患者尿液Smad1的表达及其与肾脏损伤的关系。方法 选择T2DM患者118例及正常对照组28例, 按照尿白蛋白/肌酐比值( UACR)分组，其中正常蛋白尿组64例，微量白蛋白尿组36例及大量白蛋白尿组18例。应用ELISA法测定各组尿液Smad1的含量，常规方法测定肌酐(CRE)、胱抑素C(CysC)、血糖、糖化血红蛋白、c-肽等临床指标，以Macisaac公式估算GFR，分析尿Smad1含量与常用临床指标的相关性。结果 T2DM患者尿Smad1含量高于对照组，与UACR成正相关(R=0.412， P=0.000)，正常蛋白尿组、微量蛋白尿组、大量蛋白尿组尿Smad1含量呈递增改变;相关分析显示Smad1与空腹血糖、糖化血红蛋白成正相关性，与空腹C-肽成负相关;logistic回归分析表明尿液Smad1是T2DM患者肾功能损伤的独立危险因素。结论　尿液Smad1可反映DN肾功能损伤的程度并与DN分期相关;尿液Smad1的检测对DN患者病情观察、疗效判断具有一定的临床价值。

　　【关键词】糖尿病; 糖尿病肾病; smad1;尿白蛋白/肌酐比值

　　Relationship between urinary smad1 and diabetic nephropathy in T2DM patients   FU Wen-jin, WANG Shao-bo, DENG Ren-tang, et al. The Affiliated Houjie Hospital, Guangdong Medical College, Dongguan 523945, China

　　Corresponding author: WANG Qian, E-mail: QWang020@163.com

　　【Abstract】Objective To explore the relationship between urinary smad1 and the degree of diabetes nephropathy in T2DM patients. Methods The 118 T2DM patients and 28 control subjects were enrolled in the trial. The patients were divided into 3 groups according to urine albumin/creatinine ratio (UACR), 64 in normal albuminuria group, 36 in microalbuminuria group, and 18 in macroalbuminuria group. Their urinary smad1 was measured by ELISA. Fasting plasma glucose (FPG), creatinine (CRE), serum cystatin C (CysC), glycohemoglobin A1c (HbA1c), and C-peptide (C-P) were also examined. Glomerular filtration rate (GFR) was determined by Macisaac formulae to analyze the relations between urinary smad1 and the common clinical indices. Results The level of urinary smad1 was significantly higher in the T2DM patients than in the controls and positively related with UACR in T2DM (R=0.412, P=0.000). It was getting higher in the normal albuminuria group, microalbuminuria group, and macroalbuminuria group progressively. Pearson analysis showed that the level of urinary smad1 was positively related with FPG and HbA1c, but negatively with fasting C-P. Logistic regrsssion analysis showed that the urinary smad1 was an independent risk factor in diabetic nephropathy in T2DM patients. Conclusion Urinary smad1 is related with the degree of diabetic nephropathy, and may be a promising marker for the diagnosis and monitoring the treatment of DN.

　　【key words】Diabetes mellitus; Diabetic nephropathy; Smad1; Urine albumin /creatinine ratio (UACR)