肾损伤早期诊断标志物在高强度军事训练过程中的变化  

Changes in markers for early diagnosis of kidney injury during intensive military training

作　　者：周忻[1] 林杰[1] 陈力平[1] 孔维菊[1] 李飞祥 ZHOU Xin;LIN Jie;CHEN Li-ping;KONG Wei-ju;LI Fei-xiang(The 904th Hospital of the Joint Logistics Support Unit of the Chinese People's Liberation Army,Wuxi,214044,China)

机构地区：[1]中国人民解放军联勤保障部队第九○四医院检验科,江苏无锡214044

出　　处：《中国急救复苏与灾害医学杂志》2019年第11期1056-1059,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：中国人民解放军第一○—医院课题:高强度军事训练致肾损伤的新型早期诊断标志物的研究(2017YG04)。

摘　　要：目的:探索5 km武装越野训练过程中肾损伤早期诊断标志物的变化。方法抽取某部官兵478名作为研究对象,进行负重30 kg的5 km武装越野训练,于训练前24 h,训练结束即刻以及训练结束后24 h收集尿液及血液标本,观察尿液6种生物标志物[白细胞介素(IL-18),N-乙酰-β-D氨基葡萄糖苛酶(NAG)、微量白蛋白(mALB)、肾损伤分子1(K1M-1)、中性粒细胞凝胶素相关脂质(NGAL)、尿肝脏型脂肪酸结合蛋白(L-FABP)]、2种修复标志物[人软骨糖蛋白39(YKL-40)及单核细胞趋化蛋白1(MCP-1)]、传统生物标志物(血清肌酐和肌酐激酶、尿白蛋白),以及尿液显微镜下变化。结果82.00%(392/478)的官兵血清肌酐水平升高,2.72%(13/478)的官兵出现肾小管损伤。血清肌肝、尿蛋白、尿白蛋白与肌酐比值均在训练结束即刻达到顶峰。肌肝激酶持续增加,且训练结束后24 h肌酐激酶水平明显高于训练前24 h和训练结束即刻,而滤过钠排泄分数持续降低。训练结束即刻以及训练结束后24 h尿显微镜评分次所占比例明显高于训练前24 h(P<0.01);显微镜尿沉渣检测结果显示训练结束即刻以及训练结束后24 h 349例官兵(73.01%)尿液阳性,尿沉渣中均未观察到尿酸盐等晶体。训练结束即刻检测结果显示血清肌肝激酶与YKL-40呈正相关(r=0.514,P=0.014),而与IL-18呈负相关(r=0.507,P=0.028)。结论武装越野5 km高强度军事训练官兵血清肌肝水平出现增长,尿沉淀物可诊断急性肾小管损伤。Objective To explore the changes of early diagnostic markers of kidney injury during 5 km armed crosscountry training.Methods 478 officers and soldiers were selected as the objects of study,carrying 5 km armed off-road training with a load of 30 kg.24 h before the training,training to end immediately and 24 h after training to collect urine and blood samples,urine six biomarkers(interleukins(IL-18),n-acetyl-beta-D amino glycosidase enzymes(NAG),trace albumin molecules 1(mALB),renal injury(KIM-1),Neutrogin-associated lipids(NGAL),urinary liver fatty acid binding protein(L-FABP),two repair markers(human cartilage glycoprotein 39(YKL-40)and monocyte chemokinin 1(MCP-1)),traditional biomarkers serum creatinine and creatinine kinase,urinary albumin,and urine microscopic changes were observed.Results serum creatinine levels increased by 82.00%(392/478),2.72%(13/478)had renal tubular injury.The serum ceatinine,urinary protein,the ratio of urinary albumin and creatinine reached the peak value inimedictely after training.Creatinine kinase increased all the time.The sodium filtration fraction had been decreasing.The proportion of urine microscopy score>1 of immediately after training and 24 hours after training was significantly higher than that 24 hours before training(P<0.001).The results of microscopic examination of urine sediment showed that 349 cases(73.01%)had positive urine at the moment of after training and 24 hours after training,and no crystals such as uric acid salt were observed in the urine sediment.Immediately after the training,the serum creatinine kinase presented a significant positive correlation with YKL-40(r=0.514,P=0.014),and a significant negative correlation with 11-18(r=0.507,P=0.028).Conclusion The creatinine level in armed cross-country 5 km high-intensity military training soldiers increased and urinary sediment could be used to diagnose acute renal tubular injury.Increased levels of damage and repair biomarkers suggest structural damage to the kidney.

关 键 词：高强度军事训练 急性肾损伤 标志物 

分 类 号：R466.[医药卫生—临床医学]