测定肾动脉狭窄患者尿微球蛋白的临床意义

Clinical significance of urine microglobulin in patients with renal artery stenosis(RAS)

目的 评价测定肾动脉狭窄患者尿微球蛋白的临床意义。方法 根据肾动脉造影结果 ,将 12 1例入选患者分为严重狭窄组 (肾动脉内径减少 >70 % ) 5 2例 ,轻度狭窄组 (内径减少 <70 %但 >5 0 % ) 3 1例及对照组 3 8例。测定各组尿α1 微球蛋白 (α1 MG )和 β2 微球蛋白 ( β2 MG)。结果 严重狭窄组患者尿 β2 MG较轻度狭窄组及对照组显著升高 (P <0 .0 0 1)。经多因素统计分析后 ,尿 β2 MG升高与严重肾动脉狭窄 (P =0 .0 0 0 )、左室射血分数减低 ( <0 .5 )、糖尿病、服用钙离子拮抗剂与利尿剂等因素相关。严重狭窄组尿α1 MG较其他 2组升高 (P =0 .0 12 ) ,但未高于正常上限。结论 尿 β2 MG较血清肌酐更能反映早期肾脏缺血。严重肾动脉狭窄 ( >70 % )患者多伴尿微球蛋白升高 ,提示合并肾小管功能障碍。

Objective To evaluate clinical significance of urine microglobulin in patients with renal artery stenosis(RAS).Methods According to the results of renal artery angiography,121 patients were divided into 3 groups,including 52 patients with severe RAS(lumen narrowing >70%,Group I),31 patients with mild RAS(lumen narrowing 50% ～70%,Group II) and 38 healthy people(control group).The urine α1,β2-microglobulin(MG) were recorded respectively among 3 groups.Results The urine β2-MG in group I were significantly increased compared with the other two groups(P<0.001).According to multinomial logistic regression,elevation of urine β2-MG was related to low LVEF(<0.50),diabetes,administration of CCB and diuretics.Urine α 1-MG of group I were slightly increase compared with the other two groups(P=0.012).Conclusions Urine β2-MG is a specific factor to predict renal ischemia in early stage.Severe RAS causes damage of tubular reabsorption.In patients with abnormal urine microglobulin,renal artery intervention should be performed in early stage.