早期肾损伤标志物在老年高血压肾损害检验中的应用

The Application of Early Renal Injury Markers in the Detection of Hypertensive Kidney Lesions in the Elderly

目的探讨早期肾损伤标志物在老年高血压肾损害检验中的应用价值。方法选择我院2016年1月至2017年7月体检中心抽查的280例老年(≥60岁)高血压患者作为高血压组,选择同期来医院体检的200例正常健康人作为对照组,均测定血肌酐(Scr)、胱抑素C(Cys C)、β2微球蛋白(β2-MG)、尿素氮(BUN)、视黄醇结合蛋白(RBP)、尿微量白蛋白(Um ALB)水平,比较老年高血压患者与正常健康人及不同分级高血压患者肾功能指标的差异,并测定肾小球滤过率(GFR),按是否合并肾功能损伤分为肾功能正常组与肾功能受损组,比较两组肾功能指标的差异,分析高血压GFR水平与肾损伤标志物的相关性。结果高血压组Cys C、β2-MG、RBP、Um ALB水平均高于对照组(P<0.05);高血压2级、3级患者Cys C、β2-MG、RBP、Um ALB高于高血压1级者,高血压3级患者Scr、Cys C、β2-MG、BUN、RBP、Um ALB水平均高于高血压2级者(P<0.05);高血压3级患者Cys C、β2-MG、RBP、Um ALB异常检出率均高于高血压1级、2级者(P<0.05),高血压2级患者Cys C、RBP、Um ALB异常检出率高于高血压1级者(P<0.05);肾功能受损患者Cys C、β2-MG、RBP、Um ALB均高于肾功能正常组(P<0.05);高血压患者Cys C、β2-MG、RBP、Um ALB与GFR呈负相关(P<0.05);单项检测中β2-MG对老年高血压早期肾损害检出率最高,其次为RBP,但单项检测阳性率均低于早期肾损伤标志物联合检测。结论老年高血压患者伴Cys C、β2-MG、RBP、Um ALB明显上调,且随高血压程度的增加,上述因子表达水平上调更明显,且其表达水平的变化与GFR呈明显负相关。

Objective To investigate the application value of early renal injury markers in the detection of hypertensive kidney lesions in the elderly. Methods 280 elderly patients（ over 60 years old） with hypertension treated at the medical examination center in our hospital during the period from January 2016 to June 2017 were selected by random inspection as the hypertension group,and 200 healthy people receiving physical examinations in the hospital during the same time period were selected as the control group. After admission,levels of serum creatinine（ Scr）,Cystatin C（ CysC）,β2-microglobulin（ β2-MG）,blood urea nitrogen（ BUN）,r etinol binding protein（ RBP） and urinary microalbumin（ UmALB） in two groups were determined.Renal function indexes were compared among elderly hypertensive patients,normal healthy subjects and patients with different grades of hypertension,and the glomerular filtration rate（ GFR） was determined.According to the occurrence of renal function injury,the subjects were divided into the normal renal function group and the renal function injury group,a nd renal function indexes were compared between the two groups.The correlation between the GFR level of hypertension and renal injury markers was analyzed. Results Levelsof CysC,β2-MG,RBP and UmALB in the hypertension group were higher than those in the control group（ P〈0. 05）. Levels of CysC,β2-MG,RBP and UmALB in patients with grade 2 and grade 3 hypertension were higher than those in patients with grade 1 hypertension. Levels of Scr,CysC,β2-MG,BUN,RBP and UmALB in patients with grade 3 hypertension were higher than those in patients with grade 2 hypertension（ P〈0. 05）. The detection rates of abnormal CysC,β2-MG,RBP and UmALB in patients with grade 3 hypertension were higher than those in patients with grade 1 or grade 2 hypertension（ P〈0. 05）,and the detection rates of abnormal CysC,RBP and UmALB in patients with grade 2 hypertension were higher than those in patients with grade 1 hypertension（ P〈0. 05）. Levels of CysC,β2-MG,RBP and UmALB in patients with renal function injury were higher than those in normal renal function group（ P〈0. 05）. CysC,β2-MG,RBP and UmALB were negatively correlated with GFR in hypertensive patients（ P〈0. 05）. In terms of single detection,the detection rate of early renal damage in elderly patients with hypertension by β2-MG was the highest,f ollowed by RBP. The positive rate of single detection was lower than that of combined detection of early renal damage markers. Conclusion CysC,β2-MG,RBP and UmALB are up-regulated obviously in elderly patients with hypertension. With the aggravation of hypertension,the up-regulation of above-mentioned factors is more obvious,and changes of the expression was obviously negatively correlated GFR.