原发性慢性肾小球肾炎患者尿肾上腺髓质素的变化及临床意义

The clinical significance of changed urinary adrenomedullin in chronic glomerulonephritis patients

目的探讨肾上腺髓质素(ADM)与原发性肾小球肾炎肾功能损害的关系。方法正常对照组15例,原发性慢性肾小球肾炎38例。根据内生肌酐清除率(Ccr)将患者分为四组:Ⅰ组(Ccr≥50ml/min),Ⅱ组(20ml/min≤Ccr<50ml/min),Ⅲ组(10ml/min≤Ccr<20ml/min),Ⅳ组(Ccr<10ml/min)。Ⅰ组中根据尿蛋白量分为ⅠA与ⅠB两组。采用放射免疫法检测各组尿中的ADM。结果与对照组相比,Ⅰ、Ⅱ、Ⅲ、Ⅳ组尿ADM显著降低(P值均<0.01),各组间亦有显著性差异(F=55.06,P<0.01)。在Ccr相似情况下,尿蛋白多者(ⅠB组),尿ADM水平较低,尿ADM与Scr、24h尿蛋白量呈负相关r,值分别为-0.8622(P<0.001)-、0.2939(P<0.05)。结论检测尿ADM在一定程度上可判断慢性肾炎的预后和转归。

Objective To study the role of adrenomeduUin （ADM） in renal dysfunction of primary glomerulonephritis. Methods The urinary ADM was measured by mdioinunuoassay in 15 normal subjects and 38 patients with primary glomerulonephritis.The patients were divided into four groups according to the levels of their C er, group Ⅰ （Cer ≥ 50ml/min）, Ⅱ （20ml/min ≤ Cer 〈 50ml/min）,Ⅲ（10ml/min ≤ Ccr〈20ml/min）,and Ⅳ （Ccr〈 10ml/min）.Resuits The urinary ADM concentration was less in the patients of groups Ⅰ ,Ⅱ ,Ⅲ or Ⅳ/27.96 ± 2.56,21.75 ± 3.14,16.94 ± 3.76 and 12.44 ± 3.13pg/umol.cr, respectively;p〈0.01） than control group（41.30 ± 4.47pg/umol.cr） .When compared each other, a signifcant difference was found between that of them （F = 55.06,p 〈0.01）;.In the case of same Ccr, the more the urinary protein, the lower the urinary ADM,The urinary ADM concentration was negatively with Scr （r= --0.8622;p〈0.001）,urinary protein （r= -0.2939;,P 〈0.05）.Conclusions It is potentially useful to detect urinary ADM in predicting the prognosis and outcome of patients with chronic glomerulonephritis to a certain degree.