【摘要】 目的　以尿微量白蛋白排泄率为参照 ,对比检测尿铜蓝蛋白的排泄情况 ,以了解其在青少年 1型糖尿病肾病早期检测中的价值。方法　青少年 1型糖尿病患者 4 0例 ,肾病综合征对照 2 1例 ,正常青少年对照 6 0例 ,收集 2 4h尿液。放免法测定尿微量白蛋白 ,ELISA法测定尿铜蓝蛋白。结果　糖尿病和肾病综合征组尿微量白蛋白、铜蓝蛋白较正常对照显著增加 (P <0 .0 5 ) ,糖尿病患者尿铜蓝蛋白排泄异常者占 4 7.5 % ,尿微量白蛋白异常者占 10 % ,尿铜蓝蛋白随病程增高的幅度大于尿微量白蛋白增高的幅度。尿铜蓝蛋白与尿微量白蛋白、HbA1c显著正相关。结论　尿铜蓝蛋白可能是反映青少年 1型糖尿病患者早期肾损害的更为灵敏的指标。更多还原

【Abstract】 Purpose Chronic diabetic complications like diabetic nephropathy(DN) have been the major death cause of diabetes mellitus,early detection and intervention of DN in microalbuminuria stage or early may reverse the kidney lesion,microalbumin measurement has been the wide accepted standard for DN early screening for several decades,but studies have shown it not fully correlated with kidney pathological changes,so,exploring new measurement for the early detection of DN has been one of the focus of DN researches.The aim of present study is to exploring the value of urinary ceruloplasmin screening in the early detection of diabetic nephropathy in children and adolescents with type 1 diabetes mellitus(T1DM) in contrast to the urinary microalbumin examination. Methods Forty cases of T1DM children and adolescents,twenty-one cases of nephrotic syndrome children and sixty cases normal children were recruited.Twenty four hours urine was collected and the urinary ceruloplasmin and albumin were detected by ELISA and radioimmnunoassay respectively. Results The urinary ceruloplasmin creatinine ratio(UCp/Cr) (median 1.08 ng/min) and urinary albumin excretion rate(UAER) (median 6.84 μg/min) in T1DM and nephrotic syndrome groups(UCp/Cr median 1.8 ng/mmol,UAER median 6.29 μg/min) were significantly increased comparing with normal control(UAER median 1.94 μg/min;UCp/Cr median 0.08 ng/mmol;P<0.05).47.5% of T1DM patients were found with abnormal excretion of urinary ceruloplasmin and 10% with microalbuminuria.UCp/Cr was significantly increased in UAER≥20 μg/min group(UCp/Cr median 2.65 ng/mmol) than UAER<20 μg/min group(UCp/Cr median 0.34 ng/mmol,P=0.02).UAER in diabetic patients with duration less than 2 year(UAER median 4.9 μg/min) was 1.44 times than that of duration more than 10 years(UAER median 7.08 μg/min),meanwhile,UCp/Cr in DM patients with duration less than 2 year(UCp/Cr 0.28 ng/mmol) was 2.54 times than that of duration more than 10 years(UCp/Cr 0.71 ng/mmol).The change of UCp/Cr in T1DM children and adolescents was significantly correlated with HbA 1c( r=0.45,P=0.01) and UAER( r=0.47,P=0.002). Conclusions Like early DN kidney lesion,lose of negative charge selectivity was the typical change of nephrotic syndrome(NS),UCp in NS control was significantly increased than normal control and positively correlated with UAE,so,the leakage of urinary ceruloplasmin in TIDM adolescents may due to the same change.Because the more significant increase of UCp/Cr in longer DM duration patients than UAE and more abnormal ratio of UCp/Cr than UAE in type 1 diabetes patients,urinary ceruloplasmin screening may be a potential more sensitive and noninvasive mark of early diabetes kidney lesions.更多还原