高原地区原发性肾病综合征肾小管功能改变与泼尼松疗效的关系  

Tubular damage and its relationship with effect of prednisone in patients with primary nephrotic syndrome in high altitude areas

作　　者：梅小斌[1] 陈彬[2] 易万强[2] 邹密[2] 黄浩[2] 邓永明[2] 张晓瑛[1] 张琴[1] 昌淑英[2] 尹宗芳[2] 

机构地区：[1]第二军医大学长海医院肾内科,上海200433 [2]解放军西藏军区总医院心肾内科

出　　处：《第二军医大学学报》2002年第3期305-307,共3页Academic Journal of Second Military Medical University

摘　　要：目的 :探讨高原地区 (海拔 3 680 m )原发性肾病综合征 ( PNS)肾小管功能损害与泼尼松疗效的关系。 方法 :高原地区 PNS患者经泼尼松 1m g/ ( kg· d)治疗 8周后根据疗效分为有效组 ( n=16)和无效组 ( n=12 )。于泼尼松治疗前后采用酶联免疫法测定尿视黄醇结合蛋白 ( RBP)及 N-乙酰 -β- D-氨基葡萄糖苷酶 ( NAG)、冰点法测定次晨尿渗透浓度、磺基水杨酸比浊法测定 2 4 h尿蛋白量、碱性苦味酸法测定血清肌酐。 结果 :高原地区 PNS患者泼尼松治疗前尿 RBP[( 0 .5 4± 0 .19) m g/ L ]、NAG [( 112 .84± 4 2 .82 ) U / L ]及次晨尿渗透浓度 [( 5 5 3 .62± 2 4 8.91) m mol/ L ]与正常对照组间有显著差异 ( P<0 .0 1) ;有效组与无效组相比 ,泼尼松治疗前尿 RBP[( 0 .3 3± 0 .16) vs( 0 .68± 0 .14 ) mg/ L]、NAG[( 97.4 6± 3 2 .5 3 ) vs( 15 8.65± 12 .98)U/ L]及次晨尿渗透浓度 [( 619.4 5± 4 8.92 ) vs( 3 3 7.81± 2 6.5 6) m mol/ L]均有非常显著差异 ( P<0 .0 1) ,而 2 4 h尿蛋白量 ,血清肌酐无明显差异 ( P>0 .0 5 ) ;有效组治疗后尿 RBP、NAG及次晨尿渗透浓度恢复正常 ,而无效组无明显变化。结论 :高原地区 PNS存在肾小管功能损害 。Objective:To investigate tubular damage and its relationship with the treatment effect of prednisone in patients with primary nephrotic syndrome(PNS) in high altitude of 3 680 meters. Methods: The PNS patients were treated regularly with prednisone of 1 mg/(kg·d) for 8 weeks. They were divided into 2 groups according to the treatment effect. (1)Effective group( n =16): 24 h urinary protein excretion after treatment was ≤50% of that before treatment; (2)Ineffective group( n =12):24 h urinary protein excretion after treatment was >50% of that before treatment; (3)Normal control group( n =10). The urinary retinol binding protein(RBP) and N acetal D amino glucosidase(NAG)were measured by ELISA. The urinary osmosis, 24 h urinary protein excretion and serum creatinine (Cr) were measured. Results: (1) The urinary RBP[(0.54±0.19) mg/L], NAG[(112.84±42.82) U/L] and osmosis [(553.62±248.91) mmol/L] in PNS patients were significantly higher than normal control group ( P <0.01). (2) The urinary RBP [(0.33±0.16) vs (0.68±0.14 ) mg/L], NAG [(97.46±32.53) vs (158.65±12.98) U/L] and osmosis [(619.45±48.92 ) vs (337.81±26.56) mmol/L] showed significant difference( P <0.01) between effective and ineffective group before treatment while the 24 h urinary protein excretion, serum Cr demostrated no significant difference. (3) After 8 week treatment with prednisone, the urinary RBP, NAG and osmosis in effective group recovered to normal in contrast to no significant changes in ineffective group. Conclusion: Defect of renal tubular function exist in PNS patients in high altitude. Renal tubular function may be related with the prognosis of PNS patients in high altitude.

关 键 词：肾病综合征 肾小管 泼尼松 高海拔 

分 类 号：R692[医药卫生—泌尿科学] R594.3[医药卫生—外科学]