长期糖尿病患者和高血压患者肾损伤随访分析

Follow-up Analysis about Kidney Injury of Long-term Diabetic Patients and Hypertension Patients

目的:跟踪分析病程10年以上的糖尿病患者和高血压患者肾脏损害情况。方法:选择2008年7月就诊的糖尿病患者40例,高血压患者30例,糖尿病高血压患者32例,病程均在10年以上,健康对照组100例,检测血肌酐、血尿素氮及首次晨尿微量白蛋白、颗粒管型和透明管型,并用干化学方法测定首次晨尿蛋白,之后每1年左右对患者随访检测一次,随访时间截止至2013年7月。结果:随访期间糖尿病组、高血压组及糖尿病高血压组尿微量白蛋白、颗粒管型及透明管型、干化学尿蛋白阳性率均显著高于健康体检组(P<0.01),并呈逐年上升趋势;颗粒管型检出率高于微量白蛋白、透明管型以及干化学尿蛋白;各组患者中干化学尿蛋白阴性的患者尿颗粒管型阳性率均显著高于健康体检组(P<0.01)。各组患者肌酐、血尿素氮均值显著高于健康对照组(P<0.05),但多数仍在正常范围内,部分病例发展为肾病。结论:颗粒管型、尿微量白蛋白、尿透明管型比血肌酐、尿素氮和干化学尿蛋白更敏感,定期检查有助于糖尿病肾病和高血压肾病的早期诊断;尿蛋白阴性并不能认为没有肾脏损伤,仍需要重点观察尿管型。

Objective：To analyze kidney injury of long- term diabetic patients and hypertension patients. Methods：202 participants were divided into four groups ： Diabetic group including 40 cases, hypertension group including 30 cases, dibetic hypertensive group including 32 cases ,health control group including 100 participants. The course of disease was over 10 years. Serum and first morning urine were collected. Urine microalbuminuria, granular cast, hyaline cast, urine protein, serum creatinine and serum urea nitrogen were detected. Every patient was followed up once a year. Results ：The level of urine microalbuminuria, granular cast and hyaline cast of diabetic group, hypertension group and dibetic hypertensive group was higher than health control significantly （ P 〈 0. 05 ） and increased during follow - up as well as positive rate of urine protein. The positive rate of granular cast was higher significantly than urine microalbuminuria, hyaline cast and urine protein （P 〈 0. 05 ）. The level of serum creatinine and serum urea nitrogen of diabetic group , hypertension group and dibetic hypertensive group was higher significantly than health control group （ P 〈 0.05 ）, but most of the results kept in reference ranges, only a few cases devloped into irreversible kidney injury. Conclusions：Urine microalbuminuria, granular cast and hyaline cast are more sensitive markers than serum creatinine , urea nitrogen and urine protein, and the regular detection is helpful to early diagnosis of diabetic or hypertensitive kidney injury. Urinary casts still need to be detected by microscope although the urine protein is negative.