肾早期损伤及定位标志物选择的研究  

A study of early kidney damage and the selection of positioning markers

作　　者：罗海峰[1] 杜红心[1] 林岚[1] 彭必江[1] 程钢[1] 陈蓉[1] 

机构地区：[1]重庆三峡中心医院生化科,重庆万州404000

出　　处：《重庆医学》2011年第36期3655-3656,3659,共3页Chongqing medicine

摘　　要：目的探讨晨尿中肾早期损伤标志物的选择性联合检测对诊断肾早期病理损伤及损伤部位的价值。方法采用免疫透射比浊法检测第2次晨尿中微量清蛋白(mAlb)、转铁蛋白(TRF)、免疫球蛋白G(IgG)、α1-微球蛋白(α1-MG)、视黄醇结合蛋白(RBP);采用酶速率法检测N-乙酰-β-D氨基葡萄糖苷酶(NAG)的含量,对上述检查结果异常而同时血清尿素(Urea)、肌酐(Crea)、尿酸(UA)和尿常规检测结果正常的273例患者进行肾病理活检;另选择186例健康体检者作为对照。结果肾损伤以肾病理活检结果为诊断标准,单独检测mAlb、TRF、IgG、NAG、α1-MG、RBP反映肾早期损伤的敏感性和特异性分别为92.3%和98.9%、91.2%和96.7%、85.3%和91.4%、95.2%和97.3%、93.4%和88.7%、81.6%和97.8%;联合检测(mAlb+TRF)、(mAlb+IgG)、(mAlb+TRF+IgG)、(NAG+α1-MG)、(NAG+RBP)、(NAG+α1-MG+RBP)的敏感性和特异性分别为94.8%和91.5%、93.4%和88.8%、97.8%和90.7%、94.5%和90.2%、93.3%和89.5%、96.7%和87.5%。结论联合检测肾早期损伤标志物能提高肾早期损伤的检出率及确定损伤部位,对于肾病筛查特别是高危人群的筛查有极其重要的意义。Objective To discuss the value of selective combination detection of markers of early renal damage in early morning urine in diagnosis of early renal pathological damage and the damage sites.Methods Immunoturbidimetric assay was employed to detect micro-albumin（mAlb）,transferrin（TRF）,immunoglobulin G（IgG）,α1-microglobulin（α1-MG）,retinol-binding protein（RBP） in the second morning urine.Enzyme kinetic method was adopted to measure the level of N-acetyl-β-D-glucosaminidase（NAG）.Kidney biopsy was conducted in 273 patients with abnormal test results of the above and simultaneous normal results of serum urea（Urea）,creatinine（Crea）,uric acid（UA） and urine analysis.Another 186 healthy people undergoing physical examine served as control.Results The results of kidney biopsy regarded as the diagnostic criteria of kidney damage.In diagnosis of early kidney damage,the sensitivity and specificity of mAlb,TRF,IgG,NAG,α1-MG,RBP detection alone were 92.3% and 98.9%,91.2% and 96.7%,85.3% and 91.4%,95.2% and 97.3%,93.4% and 88.7%,81.6% and 97.8%,respectively,and those of combination detection such as（mAlb＋TRF）,（mAlb＋IgG）,（mAlb＋TRF＋IgG）,（NAG＋α1-MG）,（NAG＋RBP）,（NAG＋α1-MG＋RBP） were 94.8% and 91.5%,93.4% and 88.8%,97.8% and 90.7%,94.5% and 90.2%,93.3% and 89.5%,96.7% and 87.5%,respectively.Conclusion Combination detection of positioning markers may improve the detection rate of early kidney damage and identify the damage sites,which possess extremely important significance for kidney disease screening,especially for high-risk people.

关 键 词：肾疾病 活组织检查 尿液分析 敏感性与特异性 早期诊断 

分 类 号：R692.9[医药卫生—泌尿科学]