β_2微球蛋白、Tamm－Horsfall蛋白测定对高血压病和慢性肾炎高血压诊断的临床价值

DIAGNOSTIC VALUE OF BETA_2-MICROGLOBULIN AND TAMM-HORSFALL PROTEIN FOR PATIENTS WITH ESSENTIAL HYPERTENSION AND RENAL HYPERTENSION

采用正常人和非高血压慢性肾脏病患者双重对照，测定５４例高血压病和２２例慢性肾炎高血压患者血、尿β２微球蛋白和尿Ｔａｍｍ－Ｈｏｒｓｆａｌｌ蛋白。结果：高血压Ⅰ期血β２微球蛋白增高，Ⅱ和Ⅲ期血、尿β２微球蛋白和β２微球蛋白排泄分数增高，尿Ｔａｍｍ－Ｈｏｒｓｆａｌｌ蛋白降低，提示高血压病可出现肾小球滤过功能损害。随病情发展，近、远端肾小管和管－球平衡功能亦可受损；肾炎高血压β２微球蛋白排泄分数和尿β２微球蛋白明显高于高血压各期，这提示肾炎高血压管－球平衡和近端肾小管功能损害更重，以β２微球蛋白排泄分数≥０．２０％为鉴别高血压病和慢性肾炎高血压的截断值，其准确性为８４％。

By using normal subjects and patients of chronic renal parenchymal diseases without hypertension as double controls, beta2-microglobulin (β2m) in serum and urine,and Tamm-Horsfall protein (THP) in urine were determined by radioimmunoassay in 54 patients with essential hypertension (EH)and 22 patients with renal hypertension (RH)due to chronic glomerulonephritis. The results showed that: ①by comparing with controls serum β2mlevels were increased (p<0.01)in EH at stage I,serum and urine β2m and fractional excretion of filtered β2m (FEβ2m)were increased (both p<0. 01),urine THP was decreased (p<0. 01)in EH at stage ⅡorⅢ; ②the increased serum and urine β2m and FEβ2m and decreased urine THP coincided with the severity of impairment of renal functions in EH, RH and chronic renal parenchymal diseases,and were not related to 24 hr urinary protein excretion; ③both urine β2m and FEβ2m were much higher (both p<0. 01)in RH than those in the three stages of EH. If urine β2m≥ 70 nmol/L and FEβ2m ≥0. 20% were taken as the cut-off indexes for the diagnosis of RH,the accuracies were 88% and 84 % respectively.