尿液肾功能指标监测对早期肾功能损伤的临床诊断价值

Clinical value of monitoring urinary indicators of renal function in diagnosis of early renal function damage

目的探讨尿α1微球蛋白(Uα1-MG)、尿转铁蛋白(TRU)、尿免疫球蛋白(IGU)、尿微量清蛋白(UmAlb)水平在高血压、糖尿病早期肾功能损伤的临床诊断价值。方法收集临床诊断为原发性高血压、糖尿病、肾功能不全的住院患者,并将其分为高血压组(n=209)、糖尿病组(n=140)和肾病组(n=110)。另选择体检健康者221例作为对照。留取以上4组受检者的晨尿,采用IMMAGE 800型特种蛋白分析仪,用颗粒增强散射免疫比浊法检测Uα1-MG、TRU、IGU、UmAlb。抽取空腹血分离血清,采用Hitachi7600-020型全自动生化分析仪,分别用肌氨酸氧化酶法、尿素酶法检测血肌酐(Scr)和血尿素氮(BUN)。结果高血压组、糖尿病组、肾病组患者的BUN、Scr、Uα1-MG、TRU、IGU、UmAlb水平均显著高于对照组(P<0.01)。Uα1-MG、IGU、TRU、UmAlb对肾功能早期损伤的检出率中,UmAlb最高,IGU最低;与Scr对肾功能早期损伤的检出率比较,差异有统计学意义(P<0.01);4项指标联合检测对肾功能早期损伤的检出率与UmAlb比较,差异有统计学意义(P<0.01)。结论 Uα1-MG、IGU、TRU、UmAlb是肾功能损害的早期标志物,联合检测可提高早期肾功能损害的检出率。

Objective To explore clinical value of urinary alpha-1 microglobulin（Uα1-MG）,transferrinuria（TRU）,urinary immunoglobulin（IGU）and urine microalbumin（UmAlb）levels in diagnosis of early renal function damage of patients with hypertension or diabetes mellitus.Methods Hospitalized patients diagnosed as primary hypertension,diabetes mellitus or renal insufficiency clinically were collected and divided into hypertension group（n=209）,diabetes group（n=140）and renal disease group（n=110）.221 healthy people who had accepted physical examination were served as control.Morning urine specimens were obtained from people in four groups above,IMMAGE 800 special protein analyzer was employed to detect Uα1-MG,TRU,IGU,UmAlb using particle-enhanced immunonephelometric assay.Serum were separated from fasting blood specimens.Hitachi 7600-020 automatic biochemical analyzer was adopted to measure serum creatinine（Scr）and blood urea nitrogen（BUN）using sarcosine oxidase method and urease method.Results BUN,Scr,Uα1-MG,TRU,IGU,UmAlb levels of patients in hypertension,diabetes and renal disease groups were all significant higher than those in control group（P＆lt;0.01）.Among diagnostic rates of early renal function damage by Uα1-MG,IGU,TRU and UmAlb,UmAlb detection showed the highest rate while IGU,the lowest,which demonstrated statistical differences when compared to Scr（P＆lt;0.01）.The difference was also statistically significant when compared the diagnostic rate of early renal function damage by combined detection of the four indicators to UmAlb alone（P＆lt;0.01）.Conclusion Uα1-MG,IGU,TRU,UmAlb are early biomarkers for renal function insufficiency,and their combination detection can improve the diagnostic rate of early renal function damage.