尿微量白蛋白对社区≥80岁老年人原发性高血压早期肾损害的诊断价值

The significance of urinary microalbuminuria fordiagnosis of early renal impairment occurred in the very elderly with essential hypertension in the community

目的:探讨尿微量白蛋白对社区≥80岁老年人原发性高血压早期肾损害的诊断价值。方法:≥80岁老年人原发性高血压患者85例,将其分为高血压病史≤10年(EH1组)、高血压病史>10年且≤20年(EH2组)和高血压病史>20年(EH3组)这3组。测定患者的尿微量白蛋白(mAlb),同时测定尿常规、血尿素氮(BUN)、肌酐(SCr)以及应用MDRD简化公式计算肾小球滤过率(GFR),并进行对比分析,达到以下标准之一即为阳性:mAlb>20 mg/L,尿常规蛋白阳性,BUN/SCr任何一项指标高于正常值,GFR<80 ml/min。结果:mAlb阳性率61.2%,明显高于尿常规蛋白阳性率24.7%、BUN、SCr升高率15.3%及GFR<80 ml/min率40%,差异有统计学意义(P<0.01)。EH1及EH2组mAlb阳性率较尿蛋白阳性率明显升高(P<0.01),EH3组mAlb阳性率也较之升高(P<0.05)。结论:尿微量白蛋白测定是≥80岁老年人原发性高血压肾脏早期损害的指标,与其高血压病程长短具有相关性。

Objective： To explore the significance of urinary microalbuminuria for diagnosis of early renal impairment occurred in the very elderly with essential hypertension in the community. Methods： Eighty-five cases of the very elderly over 80 with essential hypertension were divided into three groups： group EHl（disease history is equal to or less than 10 years）, group EH2（disease history is between 10 years and 20 years） and group EH3（disease history is longer than 20 years）. A comparative analysis was performed by determination of mAlb, routine urine, BUN, SCr and GFR calculated with simplified formula ＂MDRD＂. The judgment of positive just needs to only meet one of the following criteria： mAlb〉20mg/L, routine urine protein positive, any indicator in the test of BUN or SCr over the normal value, GFR〈80ml/min. Results： The positive incidence of mAlb in 85 cases reached 61.2%, apparently higher than 24.7% of the positive incidence of routine urine protein, 15.3% of the increase rate of BUN or SCr, and 40% of the ratio of GFR〈80 （ml/min）. These differences are statistically significant （P〈0.01）. In group EH 1 and EH2, the positive incidences of mAlb are obviously higher than those of routine urine protein （P〈0.01）. In group EH3, the positive incidence of mAlb is also higher than that of routine urine protein （P〈0.05）. Conclusion： Urinary microalbumin （mAlb） is a favorable indicator for the diagnosis of early renal impairment occurred in the very elderly with essential hypertension, which is related to the progress of essential hypertensive disease.