尿蛋白电泳评估肾损伤临床价值的探讨

Study on Clinical Value of Urinary Protein Electrophoresis of Assessing Renal Injury

目的通过分析不同类型肾损伤患者尿蛋白的特点,探讨尿蛋白电泳在评估肾损伤方面的临床价值。方法选取196例不同类型肾损伤患者,将其分为单纯糖尿病组49例,糖尿病并发高血压组42例,单纯高血压组48例,IgA肾病组22例,狼疮性肾炎组14例和原发性肾病综合征组21例,同时选取34例健康对照组,收集随机尿,应用十二烷基硫酸钠-聚丙烯酰胺凝胶电泳(SDS-PAGE)技术进行尿蛋白成分分析,并检测尿微量清蛋白(MAU),同时检测病例组和健康对照组的血肌酐(SCr)和尿素氮(BUN),对数据进行统计学分析。结果根据SDS-PAGE结果,将尿蛋白电泳类型分为未检出蛋白组、生理性蛋白尿组和病理性蛋白尿组,病理性蛋白尿组根据蛋白质分子量大小又分为混合14kD组、混合27kD组、肾小管性蛋白尿组、肾小球性蛋白尿组;单纯糖尿病组、单纯高血压组以肾小管性蛋白尿居多(分别占约22.4%和27.1%),糖尿病并发高血压组、IgA肾病组、狼疮性肾炎组均以混合14kD组蛋白尿为主(分别占约31.0%,36.4%,35.7%),原发性肾病综合征(PNS)组以肾小球性蛋白尿为主(占33.3%),健康对照组仅有4例在66kDa处有条带,且条带淡染,其余未检出任何条带。对各组尿MAU,SCr和BUN进行统计学分析,混合14kD组与27kD组MAU检测差异无统计学意义(P>0.05),与其他各组比较差异均有统计学意义(均P<0.05);混合14kD组SCr和BUN与其他各组比较,差异均有统计学意义(P<0.05)。结论尿蛋白电泳能够在MAU,SCr和BUN出现异常之前检测出蛋白条带,比MAU,SCr和BUN等实验指标能够更早更全面地反映肾损伤程度及部位,对判断肾损伤具有重要的临床价值。

Objective To explore the clinical value of urinary protein electrophoresis in assessing renal injury by analyzing the characteristics of urinary protein in patients with different types of renal injury. Methods The patients were divided into six groups ： pure diabetes group （n= 49）, diabetes mellitus complicated hypertension group （ n= 42）, pure hypertension group （n= 48） , IgA nephropathy group （n= 22） , lupus nephritis group （ n= 14） anti primary nephropathy syndrome group （ n= 21） , anti at the same time, selected 34 cases of healthy people. Collected random urine anti performed sodium dodecyl sulfate- polyacrylamide gel electrophoresis （SDS-PAGE） anti detected urinary microalbumin （MAU）,and at the same time,SCr anti BUN were also measured in case group anti healthy control group. The data were analyzed statistically. Results According to the results of SDS-PAGE,divided the urinary protein electrophoresis types into three groups：the group without protein, physiological proteinuria group anti pathological proteinuria. The pathological proteinuria was divided into mixed 14kD group, mixed 27kD group, renal tubular proteinuria anti glomerular proteinuria group. Among pathological proteinuria, simple diabetic anti hypertension patients were mainly renal tubular proteinuria （about 22.4% anti 27.1% respectively）. Diabetes combined with hypertension group,IgA nephropathy group anti lupus nephritis group were mainly mixing proteinuria with 14kD （about 31.0 %, 36.4% anti 35.7 % respectively）. Primary nephropathy syndrome （PNS） group accounted for 33.3 were glomerular proteinuria. Only 4 cases of healthy control group were detected the band at 66kDa with light stained band,the rest did not detect any str%p. There was no sfgnKfcant difference in MAU between 14kD group and 27kD group, but sig- nificantly different with other groups （P〈0.05）. In 14kD group, SCr and BUN compared with other groups, the difference was statistically significant （P〈0.05）. Conclusion Urine protein electrophoresis could detect protein bands before MAU, SCr and BUN abnormalities,and could reflect the degree and location of renal injury earlier and more comprehensivly than MAU, SCr and BUN, which have important clinical value in judging renal injury.