微量白蛋白尿在系统性红斑狼疮患者早期肾损害诊断中的意义

Significance of urinary albumin in patients with systemic lupus erythematosus

目的探讨微量白蛋白尿在诊断系统性红斑狼疮(SLE)早期肾损害中的意义及其与疾病活动性的相关性。方法检测104例系统性红斑狼疮患者的24小时尿白蛋白定量,分析其与临床病程、疾病活动性及免疫学指标之间的关系。结果104例患者中72例(69.2%)24小时尿白蛋白升高。在尿常规检测尿蛋白阴性患者中,47.5%(29/61)的患者24小时尿白蛋白升高(微量白蛋白尿),其中在初治和复治患者中分别有48.7%(19/39)和45.5%(10/22)的患者24小时尿白蛋白升高;初治患者尿白蛋白升高组的SLEDAI评分[(10.2±3.6)分]和血沉[(62.9±37.1)mm/1 h]较尿白蛋白正常组[分别为(6.6±2.9)分和(40.2±29.5)mm/1 h]显著升高(P均<0.05),且伴有血白蛋白降低(10/19)和免疫球蛋白升高(5/19)的比例较正常组(分别为3/20和0/20)显著增加(P均<0.05);复治患者尿白蛋白升高组的SLEDAI评分[(6.5±3.5)分]也较正常组[(3.3±2.7)分]显著升高,且伴有贫血(4/10)和血清补体降低(7/10)的比例较正常组(分别为0/12和2/12)显著增加(P均<0.05)。结论检测微量白蛋白尿有助于早期发现系统性红斑狼疮患者的肾损害,并与疾病的活动度及严重性显著相关。

Objective To investigate the significance of the urinary albumin excretion for early renal involvement in systemic lupus erythematosus（SLE）,and the relationship between urinary albumin excretion and disease activity. Methods The levels of 24 hour urinary albumin were measured by chemiluminescence in 104 patients with SLE,and the course of disease,disease activity and immunologic index were analyzed. Results In 104 SLE patients,72 （69.2%） patients were present of high proteinuria in 24 hour urinary albumin test. 47.5 % （29/61） of protein negative patients by routine urine test had albuminuria in 24 hour urinary albumin test. In the patients who were treated with or without corticosteroid or immuno-suppressive drugs, 45.5 %（10/22） or 48.7 %（19/39） respectively had high level of urinary albumin whereas urinary protein was negative. In the patients who were not treated with corticosteroid or immunosuppressive drugs,there were significant difference in the SLEDAI scores （10.2 ±3.6 vs 6.6±2.9） and erythrocyte sedimentation rate （62.9±37.1 vs 40.2±29.5） mm/l h between the patients with high level of urinary albumin and those with normal urinary albumin （ P〈0.05, respectively）. The elevation of immunoglobulin （5/19） and the reduction of serum albumin （10/19） were more common in the patients with high urinary albumin excretion than those with normal urinary albumin （3/20 and 0/20 respectively, P 〈0.05）. In the patients who were treated with corticosteroid or immuno-suppressive drugs,there was significant difference in the SLEDAI scores （6.5±3.5 vs 3.3±2.7） between the patients with high level of urinary albumin and those with normal urinary albumin. The anaemia （4/10） and the reduction of serum complement （7/10） were more common in the patients with high urinary albumin excretion than those with normal urinary albumin （0/12 and 2/12 respectively, P 〈0.05）. Conclusion The level of 24 hour urinary albumin could be used as a sensitive index for early renal involvement in SLE patients,and it is significant correlated to SLE activity and severity.