先天性脊柱畸形合并泌尿系畸形患者的肾功能评估

Evaluation of renal function in congenital spinal deformities patients with urinary malformations

目的评估先天性脊柱畸形合并泌尿系畸形患者的肾功能。方法前瞻性收集先天性脊柱畸形合并泌尿系畸形的患者和年龄、体质量相近的健康人,并分成肾脏畸形组、尿路畸形组和健康对照组。检测血肌酐、尿素、胱抑素C、估计肾小球滤过率(eGFR)用于评估患者的一般肾功能;检测尿微量白蛋白(mALB)、α1-微球蛋白(α1-MG)、β2-微球蛋白(β2-MG)和N-乙酰-β-D-葡萄糖苷酶(NAG)用于评价患者的早期肾功能。结果共募集到肾脏畸形患者16例、尿路畸形患者14例、健康对照组20例,3组之间的血肌酐、尿素、胱抑素C以及eGFR均在正常范围内,且各指标无统计学差异(P>0.05);3组之间的mALB、α1-MG以及NAG浓度存在统计学差异(P<0.05),而β2-MG浓度未见统计学差异(P>0.05);肾脏畸形组的mALB以及NAG浓度显著高于尿路畸形组,且差异有统计学意义(P<0.05),而α1-MG浓度在两组间未见明显差异(P>0.05)。结论先天性脊柱畸形合并泌尿系畸形患者存在肾功能早期损害,且相较于尿路畸形患者,肾脏畸形患者的肾损害程度更严重。

Objective To evaluate renal function in congenital spinal deformities patients with urinary malformations.Methods We prospectively enrolled patients diagnosed with congenital spinal deformities combined with urinary malformation as well as age-and weight-matched healthy individuals and divided them into three groups:renal malformations group,urinary tract malformations group,and healthy control group.Serum creatinine,blood urea,blood uric acid,serum cystatin C,and estimate glomerular filtration rate(eGFR)level were used to evaluate general renal function.Urinary microalbumin(mALB),urinary alpha-1-microglobulin(α1-MG),beta-2-microglobulin(β2-MG),and N-acetyl-beta-D-glucosaminidase(NAG)level were determined to evaluate early renal function.Results We enrolled totally 16 patients with renal malformations,14 patients with urinary tract malformations group,and 20 healthy individuals as controls.The concentration of serum creatinine,blood urea,blood uric acid,serum cystatin C,and the value of eGFR in the three groups were within normal reference values,with no significant difference(P>0.05).There were significant differences in the urinary levels of mALB,α1-MG and NAG in the three groups(P<0.05),but not for the concentration ofβ2-MG(P>0.05).Urinary levels of mALB and NAG were significantly higher in renal malformations group than in urinary tract malformations group(P<0.05),but not for the concentration ofα1-MG(P>0.05).Conclusion Early renal function impairment occurs in congenital spinal deformities children with urinary malformation.Moreover,it appears more severe in patients with renal malformations than in those with urinary tract malformations.