高血压病人的肾功能储备与早期肾损害

Renal early dysfunction and renal functional reserve of patients with essential hypertension

目的研究原发性高血压 (EH)病人的肾功能储备 ,探讨发现早期肾功能损害的指标。方法 2 7例 1级与 2级EH病人 ,收缩压 2 0 84± 1 6 2kPa,舒张压 12 41± 1 17kPa ,停用降压药 2周后收集 2 4小时尿。晨采血 5ml后 ,输入复方氨基酸 5 0 0ml,2小时内滴完 ,1小时后再采血留尿。测定氨基酸负荷前后的血压、血尿素氮、血肌酐、尿肌酐、内生肌酐清除率、尿微量白蛋白、尿α1微球蛋白、尿 β2微球蛋白、尿视黄醇结合蛋白。结果以超过正常对照组 95 %上限值为异常 ,EH病人输入氨基酸前 ,尿微量白蛋白异常 17/2 7例 (6 3 % ) ,尿α1微球蛋白 16 /2 7例 (5 9 3% ) ,尿 β2 微球蛋白 14/2 7例(5 1 9% ) ,尿视黄醇结合蛋白 2 5 /2 7例 (92 6 % ) ;而血尿素氮、血肌酐、肌酐清除率均正常。氨基酸负荷后 ,肌酐清除率较前增高 30 %是尿量增多、肌酐排泄率升高所致 ,而血压及其他指标无明显变化 (P>0 0 5 )。结论 (1)尿微量白蛋白、尿α1微球蛋白、尿 β2 微球蛋白、尿视黄醇结合蛋白测定可作为EH病人早期肾功能受损的指标。氨基酸负荷后这些指标并无明显变化 ,说明短期的高滤过未加重肾损害。 (2 )本组病人肾功能储备仍高达氨基酸负荷前肌酐清除率的 30 % ,用来监测早期肾功能损害 ,肾功能储备不如上述指标敏感。

Objective [WT5”BZ]To study the renal functional reserve (RFR) of patients with essential hypertension (EH) and the means which can find out renal early dysfunction. [WT5”HZ]Methods [WT5”BZ]27 patients with EH (SBP20.84±1.62kPa, DBP12.41±1.17kPa)had stoped having medcine for 2 week, 24 hours urine specimens and 5ml blood were collected. 500ml amino acids solution was infused in 2 hours. After 1 hour finishing infusion, the blood samples and the urine were collected again. Blood urea nitrogen (BUN), Serum creatinine (Scr), Urinary creatinine (Ucr), Creatinine clearance rate (Ccr), Urinary albumin (Ualb), Urinary α 1 microglobulin (Uα 1mg), Urinary β 2 microglobulin (Uβ 2mg), Urinary retinol binding protein (Urbp) and Blood pressure (BP) were measured before and after amino acids loading. [WT5”HZ]Results [WT5”BZ]In patients with EH, before amino acids loading, Ualb, Uα 1mg, Uβ 2mg and Urbp were abnormal in 17/27 (63%), 16/27 (59.3%), 14/27 (51.9%), 25/27 (92.6%) cases respectively. BUN, Scr, Ccr didn't change, as compared with the control group. After amino acids loading, Ccr increased by 30%, while BP, Scr, BUN, Ualb, Uα 1mg , Uβ 2mg, Urbp had no significant changes ( P >0.05). Conclusions 1. Ualb, Uα 1mg , Uβ 2mg, Urbp may be used as a marker of renal early damage in EH. 2. As a marker of renal early dysfunction, RFR was less sensitivity than Ualb, Uα 1mg , Uβ 2mg or Urbp. [WT5”HZ]