慢性镉接触者肾损伤早期诊断指标的评价

EVALUATION OF DIAGNOSTIC INDICES FOR EARLY RENAL INJURY IN PEOPLE CHRONICALLY EXPOSED TO CADMIUM

选择尿酶Ｎ－乙酰－β－Ｄ－葡萄糖苷酶（ＮＡＧ）、γ－谷胺酰转肽酶（γ－ＧＴ）、尿镉（Ｃｄ）、尿低分子蛋白（β２－ＭＧ）、尿总蛋白（ＴＰ）、尿钙（Ｃａ）为检测项目，分析、评价其作为镉致肾损伤早期效应指标的实用价值。研究表明尿ＮＡＧ和尿Ｃｄ有明显的剂量－反应关系。当尿Ｃｄ在０．０５μｍｏｌ／Ｌ（５μｇ／Ｌ）时尿ＮＡＧ异常率增高，其反应比β２－ＭＧ敏感，表明肾小管细胞损伤先于功能损伤。因此，推荐二联指标尿Ｃｄ＋ＮＡＧ作为镉致肾损伤早期筛检指标。三联指标Ｃｄ＋ＮＡＧ＋β２－ＭＧ特异度高、误诊率低，作为镉致肾损伤早期诊断指标较为合理。

Urine Cd,urine NAG,γ-GT,urine β-MG,urine TP and Ca were observed in people chronically exposed to Cd and their value for diagnosis of early renal injury due to cadmium was studied.The result showed that there was a significant dose-response relationship between urine Cd and urine NAG. When urine Cd rose over 0.05 μmol/L,the rate of abnormal level of NAG >17U/L)in urine raised markedly. NAG response to Cd was more sensitive than urine β 2-MG, indicating that renal tubule injury oc-curred earlier than functional injury. The author recommended that urine Cd combined with urine NAG may be used as an index for screening and detecting early renal injury induced by Cd;urine Cd combined with urine NAG and urine β 2-MG may be used as an in-dex for diagnosing early renal injury because of high specificity and low misdiagnosis rate.