四指标联合检测对慢性丙型肝炎患者早期肾损害诊断的价值

The Diagnostic Value of Four Markers Monitoring for Chronic Hepatitis C Patients with Early Impairment of Renal

目的探讨尿微量清蛋白(mALb)、尿N-乙酰β-D氨基葡萄糖苷酶(NAG)、尿转铁蛋白(TF)、尿α1-微球蛋白(α1-MG)对慢性丙型肝炎患者早期肾损害诊断的价值。方法液相终点散射免疫沉淀法检测尿转铁蛋白、放射免疫分析法测尿微量清蛋白、α1-微球蛋白、终点法测尿N-乙酰β-D氨基葡萄糖苷酶、终点法测尿肌酐。取随意尿5ml,离心后取上清液,对30例正常对照组和30例确诊为慢性丙型肝炎患者组联合以液相终点散射免疫沉淀法检测尿转铁蛋白;放射免疫分析法测尿微量清蛋白(mALb)、尿α1-微球蛋白(α1-MG);终点法测尿N-乙酰β-D氨基葡萄糖苷酶(NAG),同时用终点法测尿肌酐值。结果正常对照组尿TF/Ucr为1.02±0.58mg/mmol、mALb/Ucr为1.57±0.55mg/mmol、NAG/Ucr为6.25±2.18U/g、α1-MG/Ucr为1.65±0.56mg/mmol。慢性丙型肝炎患者尿TF、尿mALb、尿α1-MG、尿NAG均较对照组增高,并有显著性差异P<0.05,单项及2项检测尿mALb、TF、α1-MG、NAG阳性率低,联合其中3项检测阳性率较高,可达到63.3%,联合4项检测阳性率可达66.7%。4项联检的阳性率高于单项及2项检测的阳性率,并有显著性差异(P<0.05)。尿α1-MG与NAG呈显著正相关r=0.899,P<0.05,mALb与NAG、α1-MG无相关性,P>0.05,mALb与TF呈正相关r=0.701,P<0.05,TF与NAG,α1-MG均无相关性,P>0.05。结论慢性丙型肝炎患者可存在尿常规检查不能发现的肾小球和肾小管损害,检测尿mALb、TF、α1-MG、NAG是慢性丙型肝炎患者早期肾损害的敏感指标,联合3～4项指标有较高的检出率,对慢性丙肝患者肾损害的部位判断具有一定的价值。

Objective To probe into the diagnostic value of urine microlbumin,urine N - acetyl - β - D glucosaminidase,Urinar- ytransferin ,Urine α1- microglobumin for chronic hepatitis C patients with early impairment of renal. Methods Take optional centrifugal urinary 5ml respectively to measure Transterin with immunoturbidimetry, urinary microlbumin and urinary α1 - microglobumin with radio - immunoassay analyse,Urinary N - acetyl - β - D glucosaminidase and urinary creatinine were determined with endpoint for 30 normal groups and 30 chronic hepatitis C patients who were diagnosed. Results The level of urinary transferin, microlbumin,α1 - microglobumin, N - acetyl - β - D glucosaminidase,in the control were 1.02 ± 0. 58mg/mmol, 1.57 ± 0. 55mg/mmol, 1.65 ± 0. 56mg/mmol and 6.25 ± 2.18U/g. The level of urinary microlbumin, urinary transferin,α1 - microglobumin,N - acetyl - β - D glucosaminidase in chronic hepatitis C patients respectively were 4.11 ± 2.79 mg/mmol ,3.38 ± 3.06mg/mmol ,5.49 ± 4.37 mg/mmol,12.03 ± 3.78mg/mmol. Four markers in patients were significantly higher than those in controls P 〈 0. 05 . Measuring four markers together would raise the positive rate to 66.7% in chronic hepatitis C patients . The positive rate was low in single marker or two markers together. Measuring three or four markers together would raise the positive rate . A significant positive difference was noted among them. P 〈 0. 05 . A significant positive correction was noted between urinaryα1 - microglobumin and N - acetyl - β - D glucosaminidase r = 0. 899 P 〈 0. 05 , but no correction between microalbumin and α1 - microglobumin and N - acetyl - β - D glucosaminidase P 〉 0. 05. A significant positive correction was noted between urinary transferin and microlbumin r = 0. 701 P 〈 0. 05 ,but no correction between transferin and α1 - microglobumin and N - acetyl - β - D glucosaminidase P 〉 0. 05. Conclusions There are glomerular and tubuler lesions in chronic hepatitis C patients whose urine routine test were negative. The methods is sensitive to detect urinary microalbumin,Transterin,α1 - microglobumin,N - acetyl - β - D glucosaminidase. Measuring three or four markers together can get a higher positive rate. It is of value in detecting degree and situation of injury to kidney in patients with HCV chronic infection.