血清同型半胱氨酸等指标联合评价高血压患者肾损伤的临床价值

Clinical Value of Serum Homocysteine and Other Four Indexes in Evaluating Renal Damage of Patients with Hypertension

目的探讨血清同型半胱氨酸（Hcy）、胱抑素C（Cys-C）、β2微球蛋白（β2-MG）及尿液清蛋白/肌酐比值（Alb/Cr）、尿β2-MG等指标联合评价高血压患者肾损伤的临床价值。方法选择2013年6月到2014年6月来院诊治的226例高血压患者（根据其尿液Alb/Cr比值分为三组：正常清蛋白尿组127例,尿液Alb/Cr〈3;微量清蛋白尿组50例,尿液Alb/Cr在3-8.75之间;大量清蛋白尿组49例,尿液Alb/Cr〉8.75）和50名健康体检者,采集清晨空腹静脉血和晨尿,分别测定血清Hcy、Cys-C、β2-MG及尿液Alb、Cr、尿β2-MG,并进行统计学分析。结果血清Hcy、Cys-C、β2-MG及尿液Alb/Cr、尿β2-MG五个指标之间均具有相关性（r：0.343-0.800,P值均〈0.01）。对照组、正常清蛋白尿高血压组、微量清蛋白尿高血压组、大量清蛋白尿高血压组四组各指标总体比较,差异均有统计学意义（H：99.302-208.213,P值均〈0.01）。四组间两两比较,正常清蛋白尿组、微量清蛋白尿组、大量清蛋白尿组血清Hcy、Cys-C、β2-MG及尿液Alb/Cr、β2-MG水平均高于对照组,差异有统计学意义（u：39.672-191.530,P值均〈0.05）;正常清蛋白尿组、微量清蛋白尿组、大量清蛋白尿组血清Cys-C及尿液Alb/Cr、尿β2-MG三个指标组间差异均有统计学意义（u：37.155-191.530,P值均〈0.05）,且随病情进展有增加的趋势,但血清Hcy、β2-MG组间差异无统计学意义（u：3.152-20.141,P值均〉0.05）。结论血清Hcy、Cys-C、β2-MG及尿液Alb/Cr、β2-MG五个指标均能反映高血压早期肾损伤,且血清Cys-C及尿液Alb/Cr、β2-MG三个指标能反映高血压肾损害病情发展阶段。

Objective To investigate the clinical value of serum homocysteine（ Hcy）,Cystatin C（ Cys-C）,β2microglobulin（ β2-MG） and urinary albumin / creatinine ratio（ ALB / Cr）,β2-MG in evaluating renal damage of patients with hypertension. Methods 226 inpatients with hypertension which were divided into normal albuminuria group（ 127 cases）,microalbuminuria group（ 50 cases） and macroalbuminuria group（ 49 cases）according to the urinary ALB / Cr ratio,and 50 cases of healthy persons were involved in this study. The fasting venous blood and urine were collected. The serum Hcy,Cys-C,β2-MG and urinary ALB,Cr,β2-MG were measured. The data were analyzed with SPSS 19. 0. Results There were highly significant correlation between every two groups of serum Hcy,Cys-C,β2-MG and urinary Alb / Cr ratio,β2-MG（ P〈0. 01）. There were statistical differences in the five indexes among four groups（ P〈0. 05）. The serum Hcy,Cys-C,β2-MG and urinary Alb / Cr ratio,β2-MG in normal albuminuria group,microalbuminuria and macroalbuminuria group were all higher that those in control group（ P〈0. 05）. There were statistically significant differences in serum Cys-C,urinary Alb / Cr ratio and β2-MG between every two of the three hypertension groups（ P〈0. 05）,but no statistically significant differences in serum Hcy and β2-MG（ P〉0. 05）. Conclusion The serum Hcy,Cys-C,β2-MG and urinary ALB / Cr ratio,β2-MG can reflect the early hypertensive renal damage,and the serum CysC and urinary Alb / Cr ratio,β2-MG can further reflect the progression stage of renal damage.