尿系列微量蛋白和肾小球滤过率测定在原发性高血压病患者的临床意义

Clinical Significance of a Series of Microproteinuria and Glomerular Filtration Rate in Essential Hypertensive Patients

目的：探讨高血压肾病的早期诊断指标。方法：ＥＬＩＳＡ法测尿系列微量蛋白排泄量，并分析其影响因素。同位素９９ｍｍＴｏ－ ＤＴＰＡ清除率测定 ＧＦＲ。结果：高血压Ⅰ组（Ｓｃｒ＜ １２０ ｕｍｏｌ／Ｌ）患者的尿 ＡＬＢ浓度显著高于对照组，且随着病程延长而增加；ＲＢＰ、ＴＲＦ较对照组显著升高；ＩｇＧ在病程后期明显升高；ＮＡＧ显著高于对照组，但随病程、舒张压和血胆固醇水平变化不明显。ＩＩ组为 ３８％。结论：尿 ＡＬＢ和 ＲＢＰ可作为高血压肾损害的早期诊断指标。以９９ｍＴｃ－ ＤＴＰＡ清除率测定 ＧＦＲ更为精确。尿系列微量蛋白含量多少与肾功能损害程度似有一定关系。

Objective: To evaluate the value of early diagnostic methods of hypertensive nephropathy. Methods: A series of microproteinuria were assessed by ELISA. The relationship was analyzed between some factors and microproteinuria. The glomerular filtration rate was measured by 99mTc - DTPA. Results: Urinary ALB in hypertensive group I (Scr< 120 umol/L) was significantly higher than that in control group and increased correlated with the duration of hypertension. RBP and TRF in group I was also significantly higher than that in control group. IgG was elevated in the late stage of hypertension NAG in group I was significantly higher than that in control group, and no significant changes of NAG were observed with the duration of hypertension, the levels of diastolic pressure and hypercholesterolemia. The levels of microproteinuria in group II (Scr>=120 umol/L) were higher than those in group I. GFR in group I was 57 % of that in healthy ones; it further decreased to 38 % in group II. Conclusion: Urinary ALB and RBP may be a good marker of early intrinsic kidney injury in hypertensive patients at early stage. GFR (measured by 99mTc - DTPA) could be one of the best indexes of renal filtration function injury in hypertensive subjects. The quantity of a series microproteinuria might be related to the extent of renal injury.