指甲肌酐测定在鉴别急慢性肾功能衰竭中的应用

Nail creatinine determination in differentiation of acute and chronic renal failure

目的 探讨测定指甲肌酐在鉴别急慢性肾功能衰竭中的临床意义。方法 用碱性苦味酸法和肌氨酸氧化酶法测定 5 0例健康人、30例慢性肾功能衰竭 (chronicrenalfailure ,CRF)患者、10例急性肾功能衰竭 (acuterenalfailure ,ARF)患者指甲游离端肌酐 (nailcreatinine,Ncr)含量 ,并与 3～ 4个月前的血清肌酐 (serumcreatinne ,Scr)水平比较。结果 碱性苦味酸法测定Ncr表明 ,以 2 2 .5mg/10 0g为正常值 ,CRF组Ncr含量 (47.5 4± 17.2 8)mg/10 0g及 4个月前后Scr含量 (6 4 5 .33± 78.6 ) μmol/L、(6 4 0 .9± 77.7) μmol/L ,均显著高于正常组Ncr(10 .4 5± 6 .38)mg/10 0 g和Scr(10 6 .0± 12 .8) μmol/L(P <0 .0 1)。ARF组 4个月前Scr(10 9.1± 13.3) μmol/L ,与正常组无差别 (P >0 .0 5 ) ;发生ARF时 ,Ncr含量 (10 .12± 5 .36 )mg/10 0 g与正常组无差别 (P >0 .0 5 ) ,而Scr含量 (6 5 3.0± 80 .8) μmol/L明显高于正常组 (P <0 .0 1) ;同时用肌氨酸氧化酶法测定Ncr表明 ,若以 7.75mg/10 0 g为正常值 ,CRF患者Ncr含量为(13.75± 3.97)mg/10 0g、ARF组为 (3.86± 3.39)mg/10 0g、正常组为 (3.81± 2 .15 )mg/10 0g ,ARF组含量与正常组无差别 (P >0 .0 5 ) ,但明显低于CRF组 (P <0 .0 1)。

Objective To study the use of the nail creatinine(Ncr) determination in distinguishing the acute and chronic renal failure.Methods To determine the Ncr at distal tip of the fingernail in 50 normal individuals,30 patients with chronic renal failure,10 patients with acute renal failure with alkaline picrate method and enzymic creatinine assay method;and to compare the serum creatinine between 3 groups before and after 4 months.Results The results shows that using 22.5 mg/100 g as normal Ncr concentration,the Ncr of acute renal failure ( 10.12 ± 5.36 ) mg/100 g is similar to that of normal group ( 10.45 ± 6.38 ) mg/100 g,and is significantly lower than that of chronic renal failure ( 47.54 ± 17.28 ) mg/100 g in alkaline picrate method;the serum creatinine level of chronic renal failure is similar between before ( 645.33 ± 78.62 ) μmol/L and after 4 months ( 640.9 ± 77.7 ) μmol/L,and is significantly higher than normal group ( 106.0 ± 12.8 ) μmol/L;the serum creatinine level of acute renal failure before 4 months ( 109.1 ± 13.3 ) μmol/L is similar to normal group,and that of acute renal failure after 4 months ( 653.0 ± 80.8 ) μmol/L is significantly higher than normal group;at the same time,in enzymic creatinine assay the results shows that using 7.75 mg/100 g as normal level,the Ncr of acute renal failure ( 3.86 ± 3.39 ) mg/100 g is similar to that of normal group( 3.81 ± 2.15 ) mg/100 g,and is significantly lower than that of chronic renal failure ( 13.75 ± 3.97 ) mg/100 g.Conclusion This study confirms that the Ncr reflects the serum creatinine level before 4 months,so the Ncr measurement is of clinical value in differentiating acute from chronic renal failure.