评价肾盂尿RBP、Alb在不同时间段输尿管梗阻解除后的意义

目的在不同时间段输尿管梗阻解除后,通过检测肾盂尿中视黄醇结合蛋白(Retinoid-binding-protein,RBP)、白蛋白(Albumin,Alb)的水平变化,来探讨梗阻解除后肾功能的恢复情况。方法将102只雄性新西兰大白兔随机分组,假手术组(对照组)6只,分离出左侧输尿管上段后直接关腹;手术组96只,随机平均分成A、B、C、D周组四个组,每组24只,分别用输尿管套管法建立左侧输尿管部分梗阻模型后1、2、4、8周解除梗阻,然后每组分别在解除梗阻后0、1、2、4周(每个时间点随机选择6只)留取左侧肾盂尿液检测Alb、RBP、Cr含量,假手术组行同样方法检测作为对照。结果随着解除梗阻时间的延长,A、B、C组肾盂尿中RBP、RBP/Cr逐渐下降,其中A组RBP、RBP/Cr至2周时分别下降至(2.15±0.19)mg/L、(0.48±0.05)(与对照组比较,P>0.05),B、C组4周后仍高于正常水平(P<0.05),梗阻解除后各个时间点间两两比较,除A组外,差异均有统计学意义(P<0.05);尿Alb 2周内有所升高,2周后开始下降,经过内生肌酐校正后,A、B、C组Alb/Cr逐渐下降,至4周时A组尿Alb/Cr下降至(0.16±0.03()较对照组比较,P>0.05),B、C组尿Alb/Cr均仍高于正常水平(P<0.05),并且尿Alb/Cr梗阻解除后各个时间点间两两比较,只有至4周时才有统计学意义(P<0.05)。D组各项指标在梗阻解除后各时间段均基本无变化(P>0.05)。结论在输尿管梗阻4周内解除梗阻,随着解除时间的延长,肾功能可逐渐恢复,并且肾小管功能比肾小球功能恢复较早;若梗阻超过8周,即使解除梗阻,肾功能也难以恢复。

Objective To detect the changes of urinary Retinoid-binding-protein（RBP） and Albumin（Alb） and evaluate the recovery of renal function after relieving ureter obstruction at different time.Methods 102 male white New Zealand rabbits were randomly divided into two groups. The sham operation group（control group）had 6 rabbits and the left upper ureter was only isolated in the abdomen;Surgery group had 96 rabbits were randomly divided into four groups, A、B、C、D （each group with 24 rabbits）. Model of PUUO was set up by ureter cuff technique . Each group was respectively released obstruction after 1week, 2weeks, 4weeks ,8 weeks ,then detect urinary RBP、Alb、Cr （obstructed kidney） at 0、1、2、4weeks （6 rabbits was selected randomly at each period） after release of obstruction , control group with the same method as a contrast.Results After release of obstruction , urinary RBP、RBP/Cr level in group A, B, C gradually declined, and group A： RBP、RBP/Cr declined to （2.15±0.19）mg/L、（0.48±0.05） at 2 weeks after relief（compared with control group,P〉0.05）, Group B、C： RBP、RBP/Cr was still higher than the normal level after 4 weeks （P 〈 0.05）, each group of any two time- point was compared with each other, the difference was statistically significant （P 〈 0.05）; But urinary Alb was increased in 2 weeks, then began to declined after 2 weeks, Alb after correction of endogenous creatinine, Alb/Cr gradually declined, Group A declined to（0.16±0.03） at 2 weeks after relief（compared with control group,P〉0.05）, Group B、C： Alb/Cr was still higher than the normal level after 4 weeks （P 〈 0.05）, Each group of any two time- point was compared with each other, the difference was statistically significant only until 4 weeks after relief （P 〈 0.05）. Group D： All indicators was basically no change （P〉0.05）.Conclusion Released ureter obstruction in 4 weeks, the renal function can recover gradually and function of renal tubular was recovered earlier than glomeruli. However, if the release continues more than 8 weeks, the renal function can hardly restore though the obstruction was relieved.