肾盂尿蛋白检测与肾血流动力学改变在肾积水术后随访中的价值  

Clinical Value of Proteinuria and Renal Hemodynamics during Following up after Operation in Children with Hydronephrosis

作　　者：马洪[1] 李旭良[1] 魏光辉[1] 何大维[1] 林涛[1] 刘俊宏[1] 褚先秋[2] 

机构地区：[1]重庆医科大学附属儿童医院泌尿外科 [2]遵义医学院附属医院小儿外科,贵州遵义563003

出　　处：《实用儿科临床杂志》2007年第11期822-824,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的 探讨肾盂尿β2—微球蛋白（β2-MG）、清蛋白（Atb）、T-H糖蛋白（THP）及免疫球蛋白G（IgG）与肾血流动力学改变在小儿肾积水术后随访中的临床价值。方法 通过放射免疫法测定35例小儿肾积水术后随访期间病肾肾盂尿β2-MG、Alb、THP及IgG水平，同时测定肾盂尿肌酐（Cr），并以健侧肾盂尿作对照。35例也同期行彩色多普勒血流显像（CDFI）检测肾血流阻力指数（RI），行静脉尿路造影（IVU）及逆行造影等检查；随访3个月～8年。结果 1．尿β-MG、Alb、THP及IgG术后与对照组比较，差异均无统计学意义（Pa〉0．05）；2．尿β2-MG／Cr、Alb／Cr术后与对照组比较，差异有统计学意义（Pa〈0．05）；THP／Cr、lgG／Cr与对照组比较，无显著性差异（Pa〉0．05）；3．术后病肾各级血管RI与健肾砌比较，差异均无统计学意义（Pa〉0．05）；4．逆行造影显示肾盂输尿管吻合口均通畅，IVU检查除1例术后3个月随访者的病肾显影较健肾延迟约30min外，余病例双肾7～10min几乎同步显影。结论 小儿肾积水术后经CDFI测量病肾各级血管砌虽降至正常，但因砌检测易受诸如血浆肾素等多因素影响，尚不够准确；而经输尿管插管留取肾盂尿检测尿蛋白证实：尿β2-MG／Cr、Alb／Cr分别是评定术后病肾小管、小球整个恢复过程中理想指标；尿THP／Cr、IgG／Cr则是判定病肾功能早期恢复的可靠指标。Objective To investigate clinical value of the changes of urinary β2 - microglobulin（ β2 - MG） ,albumin（Alb） ,T - H glycoprotein（THP） ,immunoglobulin G（IgG） and hemodynamics during following up after operation in children with hydronephrosis. Methods Levels of β2 - MG,AIb,THP and IgG in pelvis urine after operation in 35 children with congenital hydronephrosis and in pelvis urine in healthy kidney as well were detected by radion immunoassays, and at the same time, urinary creatinine was detected by automatic biochemistry analyzer（ ABA ）. What＇s more,renal resistive index（RI） was measured by color Doppler flow image（CDFI）. Retrogradation renography and intravenous urography （IVU） examinations were done. Results Levels of urinary β2 - MG/Cr, Alb/Cr of hydronephrotic kidneys were more significantly different from that of normal kidneys after operation （Pa 〈 0.05 ）, whereas the rest markers were not significantly different between hydronephrotic kidneys and normal kidneys（ P 〉 0.05 ）, so was RI. The imaging time（IT） was almost synchronous between hydronephrotic kidneys and healthy kidney after opelation except for 1 case＇s operation being only 3 months. Conclusion Urinary β2 - MG/Cr is an ideal marker to evaluate nephritic tubule recovery of hydronephrotic kidneys,whereas urinary Alb/Cr is another ideal marker to evaluate glomemlus recovery of hydronephrotic kidneys in congenital hydronephrosis after operation.

关 键 词：肾孟积水 蛋白尿 血流动力学 

分 类 号：R726.9[医药卫生—儿科]