血清缺氧诱导因子-1α评估慢性缺氧患者早期肾损害的临床意义

Early stage renal injury estimated by serum hypoxia-inducible factor-1α in chronic hypoxia patients

目的探讨用缺氧诱导因子-1α(HIF-1α)在血清中的表达水平评估慢性缺氧患者早期肾损伤的临床意义。方法慢性缺氧组收集新入院,并合并重症感染、未吸氧、稳定期,动脉血气分析显示氧分压(PaO2)≤80 mmHg的慢性缺氧患者58例,平均年龄(68±3.5)岁;对照组为同期健康体检者50例,平均年龄(65±5.8)岁。依据PaO2将不同缺氧程度的患者分为Ⅰ、Ⅱ、Ⅲ级3个亚组[Ⅰ级(60 mmHg<PaO2≤80 mmHg、Ⅱ级(40 mmHg<PaO2≤60 mmHg)、Ⅲ级(PaO2≤40 mmHg)]。2组均采集清晨空腹静脉血,测定血清HIF-1α、胱抑素C(CysC)、肌酐(Scr)及估算肾小球滤过率(eGFR),并进行统计学分析。结果与对照组比较,慢性缺氧组患者血清HIF-1α、CysC水平明显升高,差异有统计学意义(P<0.05)。而eGFR及血清Scr与对照组比较差异无统计学意义(P>0.05);进一步亚组分析:①与对照组及Ⅰ级缺氧组比较,HIF-1α在Ⅱ、Ⅲ级缺氧组明显升高,CysC在Ⅰ、Ⅱ、Ⅲ级缺氧组明显升高,eGFR仅在Ⅲ级缺氧组降低,差异均有统计学意义(P<0.05),而Scr在各缺氧组中升高不显著(P>0.05);②Pearson相关性分析,血清CysC、HIF-1α与eGFR呈负性相关关系;血清HIF-1α与CysC呈正性相关关系。结论慢性缺氧患者HIF-1α、CysC在血清中呈高表达,且敏感易测,均可做为监测慢性缺氧早期肾损伤的生物标记物;慢性缺氧早期肾功能损伤与缺氧程度相关,随缺氧程度加重,肾功能损伤加重。

Objective To investigate the effects of level serum hypoxia - inducible factor - 1 α （ HIF - 1 α） on early stage renal injury in Chronic hypoxia patients. Methods The level of serum HIF - lot in 58 chronic hypoxia patients and 50 normal people were prospectively analyzed. Chronic hypoxia patients were distributed into three groups ： group I （60 mmHg 〈 PaO2≤ 80 mmHg）, group Ⅱ（40 mmHg 〈 PaO2 ≤60 mmHg） ,and group Ⅲ （PaO2 ≤40 mmHg）. Routine renal function and laboratory biomarkers of kidney injury were detected,including blood serum ereatinine （ Scr）, cystatin C （CysC） and HIF - 1 α. Estimated glomerular filtration rate （eGFR） were calculated using CKD - EPI formula. Results The level of Scr, eGFR between chronic hypoxia and control groups appeared no sig- nificant differences. But the level of serum CysC, HIF- lot were significantly increased in chronic hypoxia group compared to normal group （ P 〈 0.05 ）. The level of CysC in three groups were significantly higher than were win the control group （ P 〈 0.05 ） and the level of HIF - 1 α were significant higher in group Ⅱ and m than were in the control groups （ P 〈 0. 05 ）. The level of eGFR were significant lower in group Ⅲ than the control group（ P 〈 0. 05 ）. There was no difference in the levels of Scr between the three groups of chronic hy- poxia patients with the control group. Conclusion The levels of serum HIF - 1α are significantly increased in chronic hypoxia patients. Serum CysC and HIF - 1α is more sensitive than eGFR,Ser as to biomarkers. The serum HIF - 1α is positively associated with the degree of hypoxia and is negatively associated with eGFR. It indicates that the level of serum HIF - 1 α may become a good biomarker to predict the early stage renal injury in chronic hypoxia patients.