甘露醇导致脑出血患者肾损害的早期诊断

The early diagnosis of renal damage following mannitol therapy in cerebral hemorrhage patients

目的探讨脑出血患者应用甘露醇后肾损害的早期诊断,为避免甘露醇引起急性肾损伤提供临床前期诊断方法。方法检测296例脑出血患者甘露醇治疗前后血肌酐(Cr)、尿α1-微球蛋白(α1-MG)、微量白蛋白(ALB)、转铁蛋白(TRF)、糖苷酶(NAG)。结果脑出血患者随着甘露醇治疗时间的延长,内生肌酐清除率(Ccr)、α1-MG、TRF、ALB、NAG阳性率逐渐增加,其中α1-MG阳性率最高,TRF、ALB、NAG阳性率均高于Ccr(P<0.05)。急性肾损害患者,甘露醇作用不同时间α1-MG、NAG与脑出血未治疗组比较有统计学差异(P<0.01),甘露醇作用72 h、7 d时ALB、TRF与脑出血未治疗组比较有统计学差异(P<0.01)。结论 Ccr是早期反映肾小球滤过率的敏感指标。尿微量蛋白的检测可提高甘露醇导致脑出血患者急性肾损害的早期诊断率,其中α1-MG,最为敏感,NAG与急性肾损伤患者的相关性较好,TRF、ALB可明确提示急性肾损伤的发生,但相对滞后。通过对甘露醇治疗脑出血患者尿微量蛋白的检测可提示早期肾损害的存在。

Objective To explore the early diagnosis of renal damage after mannitol treatment in cerebral hemorrhage patients in order to provide a way to avoid acute kidney injury caused by mannitol.Methods The levels of creatinine（Cr）,urinary α1-microglobulin（α1-MG）,microalbumin（ALB）,transferrin（TRF） and glucosidase（NAG） were determined in 296 cases of cerebral hemorrhage before and after mannitol treatment.Results The positive rates of α1-MG,TRF,ALB and NAG increased with the extension of mannitol treatment time in patients with cerebral hemorrhage in which the positive rate of α1-MG was the highest,and the positive rates of TRF,ALB,TRF were higher than Ccr（P0.05）.Compared with patients before mannitol treatment,there were statistically significant differences in α1-MG and NAG levels after mannitol treatment（P0.01） and in ALB and TRF levels 72 h and 7d after mannitol treatment（P0.01） in acute renal failure patients.Conclusion The detection of urine microprotein may enhance the early diagnosis rate of acute renal failure in cerebral hemorrhage patients.α1-MG is most sensitive and NAG have good correlation with acute kidney injury in cerebral hemorrhage patients.TRF and ALB can indicate the occurrence of acute kidney injury,but not in the very early stage of the injury.