肥胖儿童早期肾脏损害指标的相关因素分析

Markers of early obesity-related renal injury in childhood

目的分析肥胖儿童早期肾脏损害的敏感指标及影响肾损害的相关因素。方法按照尿中微量白蛋白(MAU)的水平将肥胖儿童分为肥胖肾损组、肥胖非肾损组,并选择正常体重儿童作为对照组,比较不同组间尿β2微球蛋白(β2MG)、尿白蛋白(ALB)、尿IV胶原纤维蛋白(CIV),尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)的水平。并用多元线性回归进一步分析肾脏损害的危险因素。结果单因素方差分析发现,尿MAU、CIV在3组间比较均具有统计学差异(P<0.05),进一步用LSD检验发现CIV两组间比较均具有统计学差异(P<0.05),尿MAU在肥胖非肾损组与肥胖肾损组间比较具有统计学差异(P<0.05),在对照组与肥胖非肾损组间比较无统计学差异(P>0.05);多元线性回归分析显示,收缩压标准化分值(SDS-SBP)、BMI标准化分值(SDS-BMI)、CIV、TNF-α与尿MAU显著相关。结论肥胖儿童主要以肾小球损害为主;CIV预测肾小球损害是更灵敏的指标;SDS-SBP、SDS-BMI、CIV、TNF-α为儿童肥胖肾脏损害的危险因素。

Objective To analyze the sensitive markers of early obesity-related renal injury and explore the related risk factors for renal injury.Methods Obese children were divided into kidney injury obese group and nonkidney injured obese group according to urinary micro-albumin（MAU）level,and the children with normal weight served as the control group.Urinaryβ2-microglobulin（β2MG）,urinary albumin（ALB）,urinary protein collagen IV（CIV）,urinary N-acetyl-β-D-glucosaminidase（NAG）levels were compared between the groups.And risk factors for renal injury were analyzed by multivariate linear regression.Results We found that urinary MAU and CIV significantly differed among the three groups by ANOVA（P〈0.05）.Urine CIV significantly differed between any two groups（P〈0.05）.Urinary MAU differed significantly between non-kidney injured obese group and kidneyinjured obese group（P〈0.05）,but not between non-kidney injured obese group and control group（P〈0.05）.SDS-SBP,SDS-BMI,CIV and TNF-αwere closely related to renal injury in obese children by multivariate linear regression.Conclusion Obese children have mainly glomerular damage.CIV is a more sensitive indicator of glomerular damage.SDS-SBP,SDS-BMI,CIV and TNF-ɑare risk factors for obesity-related renal injury.