尿液N-乙酰-β-D氨基葡萄糖苷酶和视黄醇结合蛋白在早期肾损伤中的临床价值

The Clinical Value of Urinary N-acetyl-β-D-glucosaminidase and Retinol-Binding Protein in Early Renal Injuries

目的：探究尿液N-乙酰-β-D-氨基葡萄糖苷酶（NAG）和视黄醇结合蛋白（KBP）在早期肾损伤中的作用和意义。方法：选取福建省立医院2016年9月-2017年5月健康体检者61例作为对照组（A组），高血压病患者69例和2型糖尿病患者63例作为病例组（B、C组），检测各组尿液NAG、RBP和微量白蛋白（mAlb），比较各组间的尿NAG和RBP水平的差异；然后在B、C组中选取尿蛋白阴性、血清肌酐和尿素氮在正常参考值范围的49例患者，根据尿mAlb是否超出30mg／L，分为尿mAlb升高组7例和尿mAlb正常组42例，比较组间尿NAG和RBP阳性率的差异，并比较单项检测与尿NAG、RBP和mAlb三项联合检测的阳性率；同时收集5例肾肿瘤手术患者的尿液，比较其在术前、术后当天、术后一周不同时段的尿NAG和RBP水平的变化。结果：B、C组的尿NAG和RBP水平显著高于A组（P〈0．05）；在尿mAlb升高组中，尿NAG和RBP的阳性率分别为85．71％和71．43％，尿mAlb正常组的尿NAG和RBP的阳性率与尿mAlb升高组比较，差异无统计学意义（P〉0．05）；三项联合检测的阳性率为89．80％，高于单独检测尿RBP和mAlb，差异有统计学意义（P〈0．05），而与单独检测尿NAG的阳性率相比，差异无统计学意义（P〉0．05）；在5例肾肿瘤手术患者中，术后当天的尿NAG和1KBP的水平最高，与术前和术后一周比较差异具有统计学意义（P〈0．05），术后一周与术前比较尿NAG水平差异具有统计学意义（P〈0．05），尿RBP水平无统计学差异（P〉0．05）。结论：尿NAG和RBP是比尿mAlb更敏感的辅助诊断早期’肾损伤的指标，且可作为术后预测急性肾损伤的良好指标，具有较高的临床应用价值。

Objective： To study the effect and significance of the urinary N-acetyl-β-D-glucosaminidase （NAG） and retinol- binding protein （RBP） in early renal injuries. Methods： 61 cases of healthy subjects who came in Fujian Provincial Hospital for a checkup were chosen as control group （group A） from Sept 2016 to May 2017, and 69 patients with hypertension and 63 patients with type 2 diabetes mellitus were chosen as the case group （group B,C） , the level of urine NAG, RBP were compared. Then 49 patients whose urine protein is negative and serum creatinine and urea nitrogen are in the normal range were compared the positive rates of the level of urine NAG, RBP and mAlb. While urine from 5 patients with renal tumor surgery was collected to compare the level of urine NAG, RBP in different times including pre-operation, the first and the week after postoperative day. Results： The level of urine NAG and RBP in group B and C were significantly higher than that in group A （P〈0.05） . The level of urine NAG had the highest positive rate in the 49 patients from group B and C, the second-highest was the level of urine Pd3P, the level of urine mAlb was lowest, and the difference of positive rates had statistically significance （P〈0.05） . The positive rate of combined detection of the three indicators was 89.8%, and it was higher than that of single detection of the level of urine RBP and mAlb, which of the difference was statistically significant （P〈0.05） . And compared with the positive rate of the level of urine NAG, there was no statistically significant difference （P〉0.05） . In 5 patients with renal tumor surgery, the level of urine NAG and RBP were the highest in the the first postoperative day, compared with pre-operation and the week after operation it had statistically significant difference （P〈0.05） . The level of urine NAG in the week after operation was higher than that in the pre-operation. The level of urine RBP in the pre-operation was no significant difference than in the week after operation （P〉0.05） . Conclusion： Urinary NAG and RBP is indexes more sensitive than urinary mAlb in the auxiliary diagnosis of early renal injuries, and can be use as good indexes in the prediction of acute kidney injury after surgery, which have a high clinical application value.