肾小球滤过率、尿微量蛋白在老年患者脑小血管病中的意义

Significance of GFR and microalbuminuria in elderly patients with cerebral vascular lesions

目的探讨肾小球滤过率(GFR)、尿微量蛋白与脑小血管病的相关性。方法入选年龄大于60岁缺血性脑卒中患者,符合脑小血管病诊断标准,共78人。依据头颅磁共振表现分为单发腔梗组、多发腔梗合并脑白质病变组。选择年龄大于60岁且脑磁共振检查正常者30例纳入对照组。收集所有研究对象的一般资料并检测血清白蛋白、肌酐、胱抑素C、尿素氮、尿微量白蛋白、尿免疫球蛋白、尿转铁蛋白、尿α1微球蛋白、尿β2微球蛋白,应用MDRD计算公式软件进行GFR的计算。应用方差分析对三组研究对象的GFR及尿微量蛋白进行分析,运用spearman相关性分析探索其与影像学病灶增多的关联。结果对照组、单发腔梗组、多发腔梗合并脑白质病变组GFR分别为(105±12)m L/min、(87±8)m L/min、(70±10)m L/min。单发腔梗组、多发腔梗合并脑白质病变组分别与对照组相比,GFR均下降,差异有统计学意义(均P=0.000);尿微量蛋白均升高,差异有统计学意义(P=0.002,P=0.000)。随着影像学病灶增多,GFR与之呈负相关(r=-0.83,P=0.000),尿微量蛋白与之呈正相关(r=0.73,P=0.000)。结论 GFR和尿微量蛋白可以帮助预测脑小血管病的发病以及病变程度。

Objective To explore the correlation of glomerular filtration rate （GFR）,microalbuminuria and cerebral small vessel disease （CSVD）.Methods According to results of magnetic resonance imaging （MRI）of brain,a total of 78 patients with CSVD older than 60 years were divided into single acunar infarct group and multiple lacunar infarct with white matter lesion group and the control group including 30 healthy persons with similar age. General information was collected and creatinine,albumin,urea nitrogen,microalbuminuria,immunoglobulin urine,uri-nary transferrin,urinary α1-microglobulin,urinary β2-microglobulin,cystatin C were measured,GFR was calculated by MDRD calculation software.GFR and microalbuminuria of the three groups of patients were analyzed by Analysis of variance,the results of P 〈0.05 were analyzed for further study.Results In control group,single lacunar group,mul-tiple lacunar infarct with white matter lesion group,the results of GFR were measured respectively （105 ±12）mL /min,（87 ±8）mL /min,（70 ±10）mL/min.The levels of microalbuminuria of single lacunar infarct group and multi-ple lacunar infarct with white matter lesion group were higher than that in control group,and the differences were sta-tistically significant （P 〈0.05）.The lesions of MRI showed a negative correlation with GFR,but positive correlation with urinary protein,and the difference was statistically significant （P 〈0.05）.Conclusions GFR and microalbu-minuria can be used to predict the incidence and severity of cerebral small vessel disease.