肾脏损害检测指标在肝豆状核变性临床诊断中的应用价值

Clinical diagnosis value of kidney damage indicators in hepatolenticular degeneration

目的比较肝豆状核变性(HLD)患者的尿常规、血尿酸及肾脏超声等肾损害检测指标与非HLD肝病患者、非HLD锥体外系疾病患者之间的差异,筛选出对HLD早期诊断有意义的诊断指标。方法 185例首次入院的HLD患者(A组)、54例非HLD肝脏疾病的患者(B组)和18例非HLD其他锥体外系疾病患者(C组)为研究对象,收集其尿常规、血尿酸及肾脏超声等检测结果资料,比较各组之间的差异。结果尿常规、血尿酸及肾脏超声检查在A、B、C三组组间差异有统计学意义(χ2=10.269,P=0.006;F=61.235,P=0.000;χ2=14.869,P=0.001);A组与C组在尿常规、血尿酸之间的差异有统计学意义(χ2=9.264,P=0.002;F=52.363,P=0.000);A组与B组在血尿酸及肾脏超声检查之间的差异有统计学意义(χ2=1.143,P=0.285;F=43.213,P=0.000)。结论在有锥体外系症状的患者中出现尿常规的异常和血尿酸减低,或在不明原因的肝病患者中出现血尿酸减低及肾脏超声的异常改变,应高度怀疑HLD的可能,建议进一步做铜代谢检查以明确诊断。

Objective To screen meaningful early diagnostic criteria indices for Chinese HLD patients, based on comparison of uri- nalysis, the value of blood uric acid and kidney ultrasound examination in HLD patients, non - HLD liver disease patients, and non - HLD extrapyramidal disorder patients. Methods All 185 cases of untreated HLD patients who was first hospitalized and finally diagnosed（ Group A）, 54 cases of non - HLD liver disease patients （ Group B）, 18 cases of non - HLD extrapyramidal disorder patients （ Group C）were select-ed in this study. The meaningful early diagnostic criteria were screened by comparison of urinalysis, the value of blood uric acid and kidney ultrasound examination Results Urinalysis, the value of blood uric acid, and kidney ultrasound examination had clearly significant differ- ence among GroupA, B and C （X2 = 10. 269,P = 0. 006 ; F = 61. 235,P = 0. 000 ;X2 = 14. 869,P = 0.001 ） ; the value of blood uric acid in uri- nalysis had clearly significant difference between Group A and C （X2 = 10. 269, P = 0.006 ; F = 61. 235, P = 0. 000 ;X2 = 14.869, P = 0. 001 ） ; the value of blood uric acid, kidney ultrasound examination showed clearly significant difference between Group A and B （X2 = 1. 143, P = 0. 285;F = 43. 213 ,P = 0.000）. Conclusion Patients who have unexplained extrapyramidal disorder, with abnormal urinalysis or/and lower value of blood uric acid, or patients who have unexplained liver disease, with urinalysis, lower value of blood uric acid or/and abnormal kid- ney ultrasound, should be highly suspicious of having the possibility of HLD, and further copper metabolic examination to make clear diagno- sis is recommended.