慢性肾小球肾炎患者肾上腺髓质素、内皮素的变化及临床意义

The clinical significance of changed adrenomedullin and endothelin in chronic glomerulonephritis patients

目的 :探讨肾上腺髓质素 ( ADM)、内皮素 - 1 ( ET- 1 )与原发性慢性肾炎肾功能损害的关系及其内在联系。方法 :正常对照组 1 5例 ,慢性肾炎 38例 ,根据 Ccr将患者分为 4组。采用放射免疫法检测各组血浆与尿中的 ADM、ET- 1 ,同时检测血管紧张素 ( Ang )与醛固酮 ( ALD)。结果 :与对照组相比 , 、 、 、 组血浆 ADM显著升高 ,尿 ADM显著降低。血浆 ET- 1和尿 ET- 1显著性升高。血浆ADM与血清肌酐 ( Scr) ,2 4 h尿蛋白量呈正相关 ,而与平均动脉压 ( MAP)、血浆 Ang 和 AL D呈负相关。血浆 ET- 1与 Scr、MAP、Ang 和ALD均呈正相关。血浆 ADM与血浆 ET- 1呈正相关。尿 ADM与 Scr、2 4 h尿蛋白量呈负相关。尿 ET- 1与 2 4 h尿蛋白量、Scr呈正相关。尿 ADM与尿 ET- 1呈负相关。结论 :血浆 ADM的升高可能是代偿 ET- 1升压和促进肾脏纤维化的结果 ,对肾脏有一定的保护作用 ;ADM在肾脏疾病的治疗中可能有重要的前景。检测尿 ADM和 (或 )尿 ET-

Objective:To study the role of ADM an d ET-1 in renal dysfunction of primary glomerulonephritis. Methods: ADM, ET-1 , AngⅡand ALD were measured by radioimmuoassay in 15 normal subjects and 38 pat ients with primary glomerulonephritis,The patients were divided into four groups according to the levels of their Scr. Results: Compared with control group,the re was a significant elevation in the levels of plasma ADM of groupsⅠ,Ⅱ,Ⅲ、Ⅳ , whereas the urinary ADM concentration was less in the patients. Compared with control group, there was a significant elevation in the levels of plasma and uri nary ET-1 of groupsⅠ,Ⅱ,III orⅣ. The plasma ADM concentration was significant ly and positively correlated with Scr and urinary protein,which was negatively correlated with mean arterial pressure(MAP)、plasma AngⅡand ALD. The plasma ET -1 concentration was positively correlated with Scr, MAP, plasma AngⅡand ALD. The plasma levels of ADM and ET-1 were correlated significantly. The urinary AD M concentration was negatively. Correlated with Scr and urinary protein. The uri nary ET-1 concentration was positively correlated with urinary protein and Scr. The urinary ADM comcentration showed a negative correlation with the urinary ET -1. Conclusion: Elevation in plasma ADM level may play a compensatory role of E T-1 which contributes to vasoconstriction and renal fibrosis. ADM has a protec tive effect on renal function, which may have important perspectives in treating renal disease . It is potentially useful to measure the urinary ADM and/or ET- 1 in predicting the prognosis and outcome of patients with chronic glomeruloneph ritis to a certain degree.