原发性系统性淀粉样变性患者肾功能的临床分析  

Clinical analysis of renal function in primary systemic amyloidosis

作　　者：李锋[1] 翟勇平[1] 唐玉梅[1] 于亚平[1] 刘海宁[1] 史平[1] 宋萍[1] 周小钢[1] 安志明[1] 

机构地区：[1]南京军区南京总医院血液科,南京医学硕士210002

出　　处：《医学研究生学报》2011年第7期713-716,共4页Journal of Medical Postgraduates

基　　金：南京军区南京总医院科研基金(2010Q022)

摘　　要：目的原发性系统性淀粉样变性(amyloidosis,AL)患者有无肾小管损伤的研究较少。文中分析原发性系统性AL患者肾功能实验室指标差异,并探讨其临床意义。方法回顾性分析49例经肾活检和(或)肠黏膜活检病理确诊的原发性系统性AL患者临床资料,分成肾功能正常组33例和肾功能不全组16例,比较2组的临床和实验室指标差异,并进一步分析所有患者尿视黄醇结合蛋白(retinol binding protein,RBP)与血肌酐(serum creatinine,Scr)、内生肌酐清除率(clearance of creatinine,Ccr)、血清蛋白(Albumin,ALB)、尿素氮(blood urea nitrogen,BUN)、尿蛋白、尿轻链的相关性。结果肾功能不全组的肾小球滤过率明显低于肾功能正常组,而尿RBP值明显高于肾功能正常组。尿RBP与Scr呈显著正相关(r=0.6342,P<0.01),尿RBP与Ccr呈显著负相关(r=-0.6766,P<0.01),尿RBP与血清ALB呈显著负相关(r=-0.324,P=0.039),尿RBP与BUN呈显著正相关(r=0.496,P=0.001)。结论原发性系统性AL患者肾功能不全时存在肾小管损伤,尿RBP测定可成为原发性系统性AL患者肾功能不全的早期检测指标之一。Objective There is little knowledge about whether or not tubular injury occurs in primary systemic amyloidosis(AL) that involves kidney.This study analyzed the laboratory data on renal function in AL,to explore their clinical significances.Methods From January 2004 to May 2010,49 patients with AL were histologically diagnosed by renal and/or intestinal biopsy in our department.Multiple myelomas were excluded and all were considered multiple organs involved.These patients were divided into two groups,normal renal function and renal dysfunction groups.Clinical and laboratory data were compared between them.The correlations of urinary retinol binding protein(RBP) with serum creatinine(Scr),clearance of creatinine(Ccr),serum albumin,blood urea nitrogen(BUN),urine protein and urine light chains were further analyzed.Results There was no significant difference in clinical features such as sex and age between the two groups.The laboratory data except glomerular filtration rate(GFR) and urinary RBP in the two groups were similar.Compared with patients in normal renal function group,patients in renal dysfunction group had lower GFR but higher RBP.Urinary RBP correlated with Scr,Ccr,Serum albumin and BUN,but not with urine protein and urine light chains.Urinary RBP related positively to the level of Scr(r=0.6342,P<0.0001) and related negatively to the level of Ccr(r=-0.6766,P<0.0001).Conclusion Tubular injury accompanies glomerular damage in AL amyloidosis.Urinary RBP might be a good marker of renal dysfunction in AL patients.

关 键 词：原发性系统性淀粉样变性 尿视黄醇结合蛋白 近端肾小管 肾功能不全 血清肌酐 内生肌酐清除率 

分 类 号：R69[医药卫生—泌尿科学]