尿微量蛋白联合尿酶早期监测儿童抗生素肾损害的意义

Clinical implication of microproteinuria and urine enzyme in the detection of early renal damage by antibiotics

目的探讨尿微量白蛋白／肌酐比值（mAlb／Cr）、转铁蛋白（TRF）、IgG、α，微球蛋白（α1-MG）、β2微球蛋白（β2-MG）、视黄醇结合蛋白（RBP）及N-乙酰-β—D-氨基葡萄糖苷酶（NAG）在早期预测儿童抗生素肾损害中的临床意义。方法选取161例肺炎患儿，尿常规蛋白定性阴性，血尿素氮（BUN）和肌酐（Scr）正常，无肾脏疾病史，单独静脉滴注1种抗生素，分为青霉素类（青霉素G、阿莫西林-克拉维酸钾、替卡西林-克拉维酸钾等）、头孢菌素类（头孢唑啉、头孢呋辛、头孢曲松、头孢哌酮、头孢他定等）和大环内酯类（红霉素、阿奇霉素）三组，分别在用药前及用药7d后，观察尿mAlb／Cr、TRF、IgG、α1—MG、β2-MG、RBP、NAG及BUN、Scr的变化，并进行统计学分析。结果青霉素类组和大环内酯类组在用药前后尿系列微量蛋白和尿酶含量差异均无统计学意义（均P〉0．05）。头孢菌素类组尿液的mAlb／Cr、TRF、β2-MG和NAG测定值分别为（21．08±10．88）mg／g、（1．66±0．14）mg／L、（0．28±0．11）mg／L和（4．98±3．97）U／L，较用药前[（15．56±5．98）mg／g、（1．61±0．14）mg／L、（0．25±0．09）mg／L和（4．62±3．80）U／L]明显增高（t=-5．11、-3．24、-2．29、-2．04，P〈0．05～0．001）。BUN、Scr在各组用药前后均无明显变化（均P〉0．05）。结论尿系列微量蛋白联合尿酶的测定对抗生素早期。肾损害的判断和预警具有重要的临床价值。

Objective To analyze the clinical significance of serial microproteinuria and urease detection in early diagnosis of antibiotics damage to kidney by observing the changes of urine microalbumin/creatinine ratio （ mAlb/Cr）, transferrin （ TRF）, IgG, α1 - microglobulin （ α1 - MG ）, β2 - microglobulin （ β2 - MG ）, retinol - binding protein（RBP） and N - aeetyl - β - D - glucosamiuidase（NAG）. Methods A total of 161 children with pneumonia whose test results were normal of urine protein, blood urea nitrogen （BUN） and serum creatinine （Scr） , and had no related history of kidney diseases were selected. All the patients were divided into three groups according to antibiotics for the treatment, the penicillins （penicillin G, amoxicillin and potassium clavulanate, ticarcillin and potassium clavulanate） group, the cephalosporins （ cefazolin, cefuroxime, ceftriaxone, cefoperazone, ceftazidime） group and the macrolides （ erythromycin, azithromycin） group. Changes of mAlb/Cr, TRF, IgG, α1 - MG, β2 - MG, RBP, NAG, BUN, Scr levels of the patients one week before and after use the antibiotics were observed, and statistically analyzed. Results In the penicillins group and macrolides group, the results showed that none of the serial microproteinuria and urease changed（ all P 〉 0.05 ）. In the cephalosporins group, the urine mAlb/Cr, TRF, 132 -MG and NAG were higher than before using the antibiotics [ （ 15.56 ± 5.98 ） mg/g vs. （21.08 ± 10.88 ） mg/g, （ 1.61 ± 0.14 ） mg/L vs. （ 1.66 ± 0.14） mg/L, （0.25 ±0.09）mg/L vs. （0.28 ±0.11 ）nag/L, （4.62 ±3.80）U/L vs. （4.98 ± 3.97） U/L,t = -5. 11, - 3.24, - 2.29, - 2.04,P 〈 0.05 - 0. 001 ]. The levels of BUN and Scr revealed no change in all the patients （ all P 〉 0.05 ）. Conclusion Combined detection of serial microproteinuria and urease has great clinical significance in judgment and warning of early renal damage by antibiotics.