高血压早期肾损伤患者血清尿调节素变化及临床意义

The changes of serum uromodulin of early renal damage in patients with essential hypertension and its clinical significance

目的:探讨血清尿调节素(UMOD)检测在原发性高血压病患者早期肾损伤中的诊断价值。方法:选择2017-01—2018-01期间在我科治疗的236例原发性患者纳入研究,按照肾小球滤过率(GFR)将患者分为3组,中度及以上肾功能损伤组[A组,GFR<60 ml/(min·1.73 m2)],轻度肾功能损伤组[B组,60 ml/(min·1.73m2)≤GFR<90ml/(min·1.73m2)]和肾功能正常组[C组,GFR≥90ml/(min·1.73m2)]。另选择100例同期于我院行健康体检志愿者作为对照组(D组)。采用酶联免疫吸附试验法(ELISA)检测各组标本UMOD水平。结果:A组血清UMOD水平显著低于B组及C组,B组血清UMOD水平明显低于C组(均P<0.05)。血清UMOD与GFR呈正相关关系(r=0.387,P<0.01),与尿素氮、尿酸、肌酐、胱抑素C和尿微量白蛋白均呈负相关关系(r=-0.206、-0.175、-0.318、-0.352、-0.284,均P<0.05)。根据受试者工作特征(ROC)曲线,血清UMOD诊断原发性高血压患者早期肾损伤的最佳临界点为127.3 mg/ml,对应敏感性、特异性分别为72.5%和83.8%,ROC曲线下面积为0.816。结论:血清UMOD可能成为原发性高血压患者早期肾损伤新的诊断指标之一。

Objective：To observe the diagnostic value of serum Uromodulin（UMOD）on early renal damage in patients with essential hypertension.Method：Two hundred and thirty-six essential hypertension patients in our hospital from January 2017 to January 2018 were selected into this study.According the glomerular filtration rate,they were divided into 3 groups,group of moderate and above renal damage[A group,GFR60 ml/（min·1.73 m^2）],group of mild renal damage[B group,60 ml/（min·1.73 m^2）≤GFR90 ml/（min·1.73 m^2）]and group of normal kidney function[C group,GFR≥90 ml/（min·1.73 m^2）].Meanwhile,100 healthy volunteers were also selected into this study as control（D group）.ELISA was used to detect serum levels of UMOD.Result：The serum UMOD level in the A group was lower than those of in B group and C group（both P〈0.05）.The serum UMOD level in the B group was also lower than that of C group（P〈0.05）.The serum UMOD level was significantly positively related to GFR（r=0.387,P〈0.01）.Meanwhile,serum UMOD level was significantly inversely associated with Urea nitrogen,uric acid,creatinine,cystatin C and urinary microalbumin（r=-0.206,-0.175,-0.318,-0.352,-0.284,all P〈0.05）.Based on the ROC curve,the boundary value of serum UMOD was 127.3 mg/ml for diagnosing early renal damage in patients with essential hypertension.The sensitivity and specificity of serum UMOD in diagnosis of early renal damage were 72.5% and 83.8%,respectively.The area under the ROC curve was 0.816 of serum UMOD in diagnosis of early renal damage in patients with essential hypertension.Conclusion：The serum UMOD may be applied to burst diagnosis of early renal damage in patients with essential hypertension.