HBV相关慢性肝炎、肝硬化和肝衰竭患者肾功能早期损伤指标观察

Observation of early renal injury indexes in patients with chronic HBV-related chronic hepatitis,liver cirrhosis and hepatic failure

目的 了解乙型肝炎病毒(HBV)相关慢性肝炎、肝硬化和肝衰竭患者肾功能早期损伤的检测指标。方法 选取2016年1月至2017年12月住院治疗的血清肌酐正常的慢性HBV感染患者303例进行调查,患者分为慢性乙型肝炎组(A组)、乙型肝炎肝硬化组(B组)及HBV相关肝衰竭组(C组)。进行肾小球滤过率(eGFR)、尿微量白蛋白(MA)、血清胱抑素C(CysC)及血β2微球蛋白(β2-MG)检测。结果 3组间比较,A组患者eGFR高于B组及C组,但3组间差异无统计学意义(P>0.05)。尿MA在3组均为异常,但3组间均差异无统计学(P>0.05)。A组血β2-MG低于B组及C组(P<0.05),B和C组比较差异无统计学意义(P>0.05)。A组血CysC低于B组及C组(P<0.05),B组低于C组(P<0.05)。A组eGFR异常率低于B组及C组(P<0.05),B组与C组差异无统计学意义(P>0.05)。3组尿MA异常率差异均无统计学意义(P>0.05)。A组血β2-MG异常率低于B组及C组(P<0.05),而B组与C组差异无统计学意义(P>0.05)。A组血CysC异常率低于B组及C组(P<0.05),B组低于C组(P<0.05)。结论 HBV相关慢性肝炎、肝硬化和肝衰竭患者中,尿MA、血β2-MG及血清CysC在反映肾损伤风险方面各有优势,尤其血清CysC及血β2-MG的特异性和敏感性互为补充,为临床更早发现肾功能受损有重大意义。

Objective To investigate the early renal injury indexes in patients with chronic HBV-related chronic hepatitis,liver cirrhosis and hepatic failure.Methods A total of 303 patients with chronic HBV infection and normal creatinine levels,who were treated in our hospital from January 2016 to December 2017,were divided into chronic hepatitis B group(group A),hepatitis B-induced cirrhosis group(group B)and HBV-related hepatic failure group(group C).The glomerular filtration rate(eGFR),urinary albumin(MA),serum cystatin(CysC)andβ2 microglobulin(β2-MG)were detected and compared.Results The eGFR levels in group A were higher than those in group B and group C,but there were no significant differences among the three groups(P>0.05).MA levels were found abnormal in the three groups,but there were no significant differences among the three groups(P>0.05).Theβ2 MG levels in group A were significantly lower than those in group B and C(P<0.05),but there were no significant differences between group B and group C(P>0.05).The CysC levels in group A were significantly lower than those in group B and C(P<0.05),which in group B were significantly lower than those in group C(P<0.05).Moreover the abnormality rate of eGFR in group A was significantly lower than that in group B and C(P<0.05),however,there was no significant difference between group B and group C(P>0.05).Furthermore,there was no significant difference in the abnormality rate of MA among the three groups(P>0.05).And the abnormality rate ofβ2 MG in group A was significantly lower than that in group B and group C(P<0.05),but there was no significant difference between group B and group C(P>0.05).The abnormality rate of CysC in group A was significantly lower than that in group B and C(P<0.05),which in group B was significantly lower than that in group C(P<0.05).Conclusion For patients with chronic HBV-related hepatitis,liver cirrhosis and hepatic failure,MA,β2-MG and CysC have their own advantages in indicating the risk of renal injury,especially the specificity and sensitivity of the last two factors which are complementary to each other.This is of great significance for the early detection of impaired renal function in clinical practice.