不同尿液蛋白测定对早期高血压性肾损害的诊断价值及临床意义

Diagnosis value and clinical significance of different urine protein determination to early hypertensive renal damage

目的探讨尿液胱蛋白酶抑制剂C（CystatinC）、α-微量球蛋白（α1-MG）、N-乙酰-β-D-氨基葡萄糖苷酶（NAG）、β2-微球蛋白（β2-MG）和微量白蛋白（mALB）的测定，对高血压早期肾损害诊断的敏感性及其临床意义。方法选择2010年3月-2010年10月在我科住院或门诊体检并明确诊断为原发性高血压患者55例作为病例组，健康体检者38例为对照组。检测两组尿CystatinC、α1-MG、NAG、β2-MG、mALB的含量，并以ROC曲线分析其敏感性。结果病例组尿液中的Cystatin C、α—MG、NAG、β2-MG、mALB含量明显高于正常对照组（P〈0．001），其中尿α1，MG曲线下面积为0．906，β2-MG曲线下面积为0．855，较尿mALB、CystatinC、NAG具有较高的敏感性（P〈0．001）。结论尿α1-MG和β2-MG的检测对诊断高血压早期肾损害的敏感性高于尿mALB、CystatinC和NAG，尿液中不同蛋白的联合检测有助于高血压肾损害的早期监测，对预防高血压性肾病的发生、发展具有重要的临床价值。

Objective To investigate the sensitive index and clinical significance of urine micro proteinase inhibitor C （Cystatin C ）, α1-micro globulin （cq-MG）, N-acetyl-β-D-amino grape glycosidase （NAG）, β2-microballoons protein（β2-MG） and micro albumin （mALB） in early renal injury caused by primary hypertension. Methods 55 patients with primary hypertension from in-patients or out-patientswere enrolled,from March 2010 to October 2010,38 subjects of healthy people for the outpatient were selected as control group. Two groups were examined with urinate Cystatin C,α1-MG, NAG, β2-MG and mALB. Results In hypertension group,urine Cystatin C,α1-MG,NAG,β2-MG and the mALB lever were higher than the normal control group significantly（ P 〈 0. 001 ）, he area under the urinary α1-MG curve was 0. 906, the area under the urinary β2-MG curve was 0. 855, it was more sensitive compared with urinary mALB, cystatin C and NAG（ P 〈 0. 001 ）. Conclusions The detection of Urine α1-MG and β2- MG was more sensitive than mALB, Cystatin C and NAG in early renal injury caused by primary hypertension. The five kinds of union examination could be helpful in early detection of hypertensive renel injury, and there were important clinical value in the prevention of hypertensive renel injury.