Urinarni biomarkeri u ranoj dijagnozi dijabetesne bolesti bubrega i dijabetesne retinopatije
Sažetak
Uvod/Cilj
Urinarni biomarkeri predstavljaju značajne indikatore renalne lezije kod pacijenata sa dijabetesom tipa 2, a pojedini od njih mogu ukazivati i na rani nastanak mikrovaskularnih komplikacija.Dijabetesna bolest bubrega (DBB) je najčešća mikrovaskularna komplikacija dijabetesa i vodeći uzrok hronične bubrežne bolesti i terminalne bubrežne insuficijencije. Iako je mikrolabuminurija prihvaćeni rani marker bubrežnog oštećenja, njena ograničena snzitivnosti i specifičnost nameću potrebu za novim urinarnim biomarkerima koji bi omogućili raniju dijagnozu renalnog oboljenja. Cilj ove studije bio je da se proceni da li urinarni kolagen tip IV, transferin i vezujući protein masnih kiselina jetre (L-FABP) mogu poslužiti kao rani biomarkeri dijabetesne bolesti bubrega, kao i da se ispita njihova povezanost sa dijabetesnom retinopatijom
Metode
Studija je uključila 80 pacijenata sa dijabetesom tipa 2, podeljenih u dve grupe: grupa 1 – normoalbuminurični (≤30 mg/dan) i grupa 2 – mikroalbuminurični (30–300 mg/dan). Deset zdravih osoba je služilo kao kontrolna grupa. Svi ispitanici su bili stariji od 18 godina, sa trajanjem dijabetesa dužim od jedne godine I procenjenom jačinom glomerulske filtracije (eGFR) >60 ml/min/1,73 m². Koncentracije kolagena tip IV, transferina i L-FABP određivane su u 24-časovnim i prvim jutarnjim uzorcima urina primenom visoko senzitivnih ELISA testova. Statistička analiza obuhvatila je poredjenje grupa, testiranje korelacija I procenu dijagnostičkih performansi pomoću ROC krive.
Rezultati
Urinarne koncentracije svih ispitivanih biomarkera su bile zanemarljive kod zdravih kontrola, ali su bile značajno više kod mikroalbuminuričnih u poređenju sa normoalbuminuričnim pacijentima (p < 0.05). Najveći dijagnostički potencijal za rano otkrivanje DKD imao je kolagen tip IV (90,4%). Svi biomerkeri su pokazali pozitivnu korelaciju sa prisustvom DKD, dok je urinarni transferrin dodatno bio povezan sa dijabetesnom retinopatijom.
Zaključak
Urinarni kolagen tipa IV, transferin i L-FABP predstavljaju obećavajuće rane biomarkere dijabetesne bubrežne bolesti, sa većim dijagnostičkim potencijalom u poređenju sa albuminurijom. Pored toga, urinarni transferin može služiti kao neinvazivni marker za rano otkrivanje dijabetesne retinopatije, što potvrđuje njegovu ulogu u praćenju mikrovaskularnih komplikacija kod pacijenata sa dijabetes melitusom tipa 2.
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