四种尿微量蛋白检测早期预测造影剂肾损害的意义  

The clinical significance of four kinds of microalbuminuria detection in early diagnosis of iodinated contrast agent damage to kidney

作　　者：李枫[1] 徐学彬[1] 徐东进[1] 张卫娟[1] 王其虎[1] 汪蛟龙[1] 

机构地区：[1]安徽理工大学附属医院淮南东方医院集团总院心血管内科,安徽省淮南232001

出　　处：《中国基层医药》2013年第21期3258-3260,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 通过研究患者尿液中的微量清蛋白（mAlb）、免疫球蛋白G（IgG）、α1微球蛋白（α1-MG）和β2微球蛋白（β2-MG）的含量变化,评价四种尿微量蛋白定量指标对早期预测造影剂肾损害的临床意义.方法 选择接受经皮冠状动脉介入诊疗的患者106例,根据造影剂的用量将患者分为两组：A组（造影剂量＜100 ml,n=51）、B组（造影剂量≥100 ml,n =55）.观察患者术前、术后尿液的mAlb、IgG、α1-MG和β2-MG的含量,血清肌酐（Scr）,内生肌酐清除率（eGFR）的变化.结果 A组尿的α1-MG和β2-MG的含量较术前升高（t=-6.748、-11.173,均P＜0.05）.B组术后24 h尿液的mAlb、IgG、α1-MG和β2-MG的含量较术前有升高,差异有统计学意义（t=-6.223、-3.518、-10.773、-11.532、-10.773,均P＜0.05）；两组组间相比,术后mAlb、IgG、α1-MG和β2-MG含量升高差异有统计学意义（F=27.306、4.704、5.118、19.011,均P＜0.05）.结论 四项尿微量蛋白检测有助于早期发现造影剂肾损害和评价造影剂肾损害的程度.造影剂肾损害最早表现为对肾小管的损害.当造影剂用量≥100 ml时,出现肾小球损害.Objective To analyze the clinical significance of four kinds of microalbuminuria detection in early diagnosis of iodinated contrast agent damage to kidney by studying four elements in the patients＇ urine：microalbumin （mAlb）,immunoglobulin G （IgG）,α1-microglobulin （α1-MG） and β2-microglobulin （β2-MG）.Methods 106 patients who have received percutaneous coronary interventional therapy were chosen and divided into group A（angiography dose ＜ 100ml,n =51） and group B （angiography dose ≥ 100ml,n =55） according to the amount of contrast agent used.Changes in the amount of mAlb,IgG,α1-MG and β2-MG levels,serum creatinine（Scr）,endogenous creatinine clearance rate（eGFR） in the urine of the patients before and after the surgery were observed.Results Postoperative α1-MG and β2-MG levels in the urine of group A higher than before surgery （t =-6.748,-11.173,all P ＜0.0 5）.2 4 hours after the surgery,mA1b,IgG,α1-MG and β2-MG levels in group B were elevated than before surgery,and the differences were significant（t =-6.223,-3.518,-11.532,-10.773,all P ＜ 0.05）.Two groups had significant differences in terms of mAlb,IgG,α1-MG and β2-MG levels after the surgery （F =27.306,4.704,5.118,19.011,all P ＜ 0.05）.Conclusion Four kinds of microalbuminuria detecting are conducive to early diagnosis of iodinated contrast agent damage to kidney and assessing the damage degree.The contrast agent damage to kidney first occurs as the renal tubular damage.When the contrast agent was used at a dosage of more than 100ml,glomerular damage occurred.

关 键 词：肾损害 放射学 介入性 尿微量蛋白 碘造影剂 

分 类 号：R446.12[医药卫生—诊断学]