三种蛋白联合检测对痛风患者肾损害的评估——附96例报告

Evaluation of the renal function in gouty patients with combined testing of albumin,β_2-microglobulin and Tamm-Horsfall protein

目的 :探讨白蛋白、β2 微球蛋白和托 霍蛋白 (Tamm Horsfallprotein ,THP)联合检测对评估痛风患者早期肾损害的价值。方法 :采用放射免疫法 ,检测 96例急性痛风性关节炎患者的尿白蛋白 ,血、尿 β2 微球蛋白及血、尿托 霍蛋白水平 ,并对反映肾损害的诸因素进行相关分析。结果 :96例尿白蛋白 ,血、尿 β2 微球蛋白水平显著高于对照组 (P <0 0 1) ;血、尿托 霍蛋白水平显著低于对照组 (P <0 0 1)。降尿酸治疗 1个月后 ,尿白蛋白、血 β2 微球蛋白有所恢复 ,但与治疗前比较差异无统计学意义(P >0 0 5 ) ;而尿β2 微球蛋白和血、尿托 霍蛋白较治疗前有显著改善 (P <0 0 1)。相关分析显示 ,尿白蛋白分别与血 β2 微球蛋白、血清肌酐呈正相关 (r =0 4 6 3、r =0 4 33) ;与肌酐清除率呈负相关 (r =-0 4 5 3)。肾图、肾B超异常的患者的尿 β2 微球蛋白及托 霍蛋白显著高于肾图、肾B超正常的患者。结论 :白蛋白、β2 微球蛋白和托 霍蛋白联合检测可作为痛风患者早期肾损害的指标 ,积极的降尿酸治疗 ,早期肾功能损害可恢复。

Objective:To investigate the value of combined testing of albumin (Alb),β 2-microglobulin (β 2-MG) and Tamm-Horsfall protein (THP) for evaluating early renal function impairment in patients with acute gouty arthritis.Methods:The levels of urine Alb,blood and urinary β 2-MG and THP levels were measured in 96 patients with acute gouty arthritis by radioimmunoassay(RIA).Results:Compared with the normal control groups, the levels of urinary Alb, blood and urinary β 2-MG in 96 patients significantly increased(P<0.001),while the blood and urinary THP levels decreased(P<0.001).There was no significant changes in urinary Alb and blood β 2-MG(P>0.05) but significant improvement in urinary β 2-MG and blood and urinary THP(P<0.01) after one month of uric acid-reducing treatment.The levels of urine Alb correlated positively with blood β 2-MG and serum Cr (r=0.463,P<0.01;r=0.433,P<0.01) while correlated negatively with Ccr(r=-0.453,P<0.01).Urinary β 2-MG and THP levels were significantly higher in patients with abnormal renogram and B-ultrasonography than those in patients with normal renogram and B-ultrasonography.Conclusion:Combined testing of Alb,β 2-MG and THP is effective in evaluating early renal function impairment in gouty patients who may completely recover following aggressive uric acid-reducing treatment.