慢性阻塞性肺疾病患者微量白蛋白尿的临床意义

Microalbuminuria clinical significance of patients with chronic obstractive pulmonary disease

目的探讨慢性阻塞性肺疾病(COPD)患者微量白蛋白尿的临床意义。方法选择COPD急性加重患者358例,肾脏疾病、心血管疾病、恶性肿瘤、哮喘疾病患者除外。根据尿中微量白蛋白水平将其分为两组:微量白蛋白尿组86例和正常白蛋白尿组272例。比较两组患者的临床及分析数据,包括肺功能、血气分析、肾小球滤过率(GFR)、血尿素(BUN)、血肌酐(SCr)以及肾小管损伤的标记物肾损伤分子-1(KIM-1)和中性粒细胞明胶酶相关载脂蛋白(NGAL)。结果 COPD患者尿微量白蛋白水平与患者吸烟时间长短、年龄、性别无相关性(均P>0.05)。尿微量白蛋白与患者血氧分压呈明显负相关(r=-0.586,P<0.001)。与正常白蛋白尿组比较,微量白蛋白尿组COPD患者动脉收缩压、心率明显升高,差异有统计学意义(均P<0.05)。两组COPD患者GFR、BUN、SCr及尿KIM-1和NGAL值差异均无统计学意义(均P>0.05)。结论COPD患者出现微量白蛋白尿与低氧血症密切相关,微量白蛋白尿可能是预示COPD患者发生心血管疾病的危险因素。

[Objective]To invesgate the microalbuminuria clinical significance of patients with chronic obstructive pulmonary disease.[Methods]385 patients with acute exacerbations of COPD were selected. Subjects were excluded if known history of renal disease, cardiovascular disease, malignancy or asthma. The patients were divided into two groups according to urinary microalbumin： microalbuminuria group and normal microalbumin group. Clinical and historical data were compared form patient records, hospital and laboratory databases between two groups： lung function, arterial blood gases, glomerular filtration rate（GFR）, blood urea nitrogen（BUN）, serum creatinine（SCr） and proximal tubular damage biomarkers： Kidney injury molecule-1（KIM-1） and Neutrophil gelatinase- associated lipocalin（NGAL）. [Results]Microalbuminuria levels was observed in 86 patients（24%） and normal microalbumin levels in 272 patients. Microalbuminuria levels was not associated with pack-years smoked, age, sex in multivariated analyses of the COPD patient（P〉0.05）. We observed increased microalbuminuria associated with decreased Pa O2（r=-0.586, P〈0.001）. Increasing microalbuminuria levels was signaticantly associated with the strileing increased systolic arterial pressure and heart rate. GFR、BUN、SCr 、Urinary KIM-1 and NGAL were not different between patients in two groups（P〉0.05）. [Conclusion]Microalbuminuria is frequent in patients with COPD and is associated with hypoxemia. The microalbuminuria levels might help to identify patients with COPD at increased cardiovascular risk.