尿海藻糖酶对近端肾小管损伤的临床意义

Significance of urinary trehalase in patients with proximal tubular interstitial injury

目的探讨尿海藻糖酶(trehalase,T)活性测定在判断近端肾小管损伤的临床意义。方法116例经临床确诊的肾脏疾病患者,分为慢性肾小球肾炎、肾病综合征、慢性肾衰、尿毒症和肾移植5组,分别测定其尿中海藻糖酶(T)、β2-微球蛋白(β2-MG)、碱性磷酸酶(ALP)和N-乙酰-β-D-氨基葡萄糖苷酶(NAG),分析T与其余三者之间的相关性,敏感性以及不同组肾脏疾病中尿海藻糖酶活性。结果尿中T活性与β2-MG、ALP、NAG均有显著相关性。116例患者中尿T升高者90例(77.59%),β2-MG升高者69例(59.48%),ALP升高者51例(43.97%),NAG升高者58例(50.00%)。尿T活性升高者中有64.44%尿β2-MG升高、47.78%尿ALP升高、51.11%尿NAG升高,而69例尿β2-MG升高者中84.01%、51例ALP升高者中84.31%、58例NAG升高者中79.31%尿T活性升高。尿T活性在肾病综合征时与在慢性肾小球肾炎和尿毒症时的差异均有显著性意义。尿T活性在慢性肾小球肾炎与其它指标的差异均有显著性意义,在肾病综合征和慢性肾衰时与ALP和NAG的差异均有显著性意义。结论尿T能比β2-MG、ALP和NAG更特异敏感地反映近端肾小管损伤及其程度,值得进一步研究和推广。

[Objective]To investigate the significance of determination of urinary trehalase activity in patients with proximal tubular-interstitial injury. 116 patients with renal disease proved by clinical diagnosis, were enrolled in this study, and they were divided into five groups, which were chronic glomerulonephrities, nephroticsyndrome, chronic renal failure, uremia and kidney graft. The urinary trehalase (T) activity, β2-microglobulin (β2-MG), Alkaline phosphatase(ALP), N-Acetyl-β-D-glucosaminidase (NAG) were determined in all patients. The co-relationship, sensitivity between these index and the relationship of these index with the different group were also analyzed. The urinary T activity had significant co-relationship with that of β2-MG, ALP and NAG. In the 116 patients investigated, urinary T activity in 90 (77.59%), urinary β2-MG in 69(59.48%), urinary ALP in 51(43.97%) and urinary NAG in 58(50.00%) of the patients increased respectively. In patients with increasing urinary T activity, there were 64.44% of the patients associated with abnormal urinary β2-MG,47.78% with abnormal ALP and 51.11% with abnormal NAG. While in patients with abnormal urinary β2-MG, ALP and NAG, there were 84.01%, 84.31% and 79.31% of patients associated with abnormal urinary T activity respectively. In patients with nephroticsyndrome the urinary T activity was significantly higher than that of chronic glomerulonephrities or chronic renal failure. In patients with chronic glomerulonephrities the urinary T activity was significantly higher than urinary β2-MG, ALP and NAG. In patients with nephroticsyndrome and chronic renal failure the urinary T activity was significantly higher than urinary ALP and NAG. [Conclusions] The urinary T activity can be well correlated with β2-MG, ALP and NAG, and more specific sensitive than those as an index of proximal tubular injury. The increse of urinary T activity may be associated with the degree of renal proximal tubular damage.