高尿酸血症肾皮质损伤后的肾脏超声变化  

Renal ultrasound changes after renal cortex injury in hyperuricemia

作　　者：吴德评 刁雪红 张德先 夏依旦·米吉提 徐颖 管昊晨 郑玉琪 周璕 叶志斌 肖婧 Wu Deping;Diao Xuehong;Zhang Dexian;Xiayidan Mijiti;Xu Ying;Guan Haochen;Zheng Yuqi;Zhou Xun;Ye Zhibin;Xiao Jing(Department of Nephrology,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China;Department of Ultrasound,Huadong Hospital affiliated to Fudan University,Shanghai,200040,P.R.China;Shanghai Key Laboratory of Clinical Geriatric Medicine,Shanghai,200040,P.R.China)

机构地区：[1]复旦大学附属华东医院肾内科,上海200040 [2]复旦大学附属华东医院超声科,上海200040 [3]上海临床老年医学重点实验室,上海200040

出　　处：《老年医学与保健》2024年第1期179-184,共6页Geriatrics & Health Care

基　　金：上海市科学技术委员会“科技创新行动计划”医学创新研究专项项目—面上项目(21Y11904000)。

摘　　要：目的研究高尿酸血症(hyperuricemia,HUA)肾皮质损伤的超声变化。方法一共15只雄性SD大鼠随机分为3组(每组5只),包括正常组(Cont组)、模型组(HUA组)和非布司他治疗组(HUA+Feb组,Feb 3 mg/kg·d)。所有大鼠自由随意饮水和喂养普通饲料。HUA组大鼠用氧嗪酸(OA,750 mg/kg·d)灌胃8周诱导成模。HUA+Feb组大鼠于第五周开始用非布司他灌胃4周。8周后检测血清尿素氮(BUN)、血肌酐(Scr)和血尿酸(Sua)水平。测定大鼠肾皮质组织中的钠钾ATP酶(NKA)活性和NKAα1亚单位蛋白表达,并通过超声观察大鼠肾脏结构、检测皮质回声。计算肾/脾回声强度比(K/S)。此外,临床上共招募在复旦大学附属华东医院接受肾脏B超检测的正常对照(n=44)和HUA受试者(n=46),并收集他们的基本临床信息并进行比较。结果动物实验结果显示,与Cont组大鼠相比,HUA组的Sua水平升高(P<0.05),NKA活性降低(P<0.05)。与HUA组相比,HUA+Feb组的Sua水平降低(P<0.05),NKA活性和NKAα1蛋白表达增加(P<0.05)。超声结果显示,HUA组的肾皮质回声高于Cont组(P<0.05),非布司他治疗后4周,HUA+Feb组大鼠肾皮质回声显著改善(P<0.05),且K/S比值低于HUA组(P<0.05)。大鼠肾脏长度、宽度和肾实质厚度在各组间无明显差异(P>0.05)。临床数据显示,HUA患者表现为肾皮质回声增强,结晶增多以及结构欠清,部分伴有多发小囊灶形成。结论HUA早期肾脏损伤的同时伴有肾脏皮质回声增强,因此超声可能用作非侵入性的影像工具,以评估早期HUA引起的肾脏损伤。Objective To explore the ultrasound changes of renal cortex injury in hyperuricemia(HUA).Methods A total of 15 male SD rats were randomly divided into 3 groups(n=5 in each group),including normal group(Cont group),model group(HUA group)and febuxostat treatment group(HUA+Feb group,Feb 3 mg/kg·d).All rats were free to drink water and fed with regular feed.The rats in the HUA group were induced into models by gavage of oxazine acid(OA,750 mg/kg·d)for 8 weeks.The rats in the HUA+Feb group were given febuxostat by gavage for 4 weeks starting from the 5th week.After 8 weeks,the levels of serum urea nitrogen(BUN),blood creatinine(Scr)and blood uric acid(Sua)were detected.The activity of sodium-potassium ATPase(NKA)and the expression of NKA-α1 subunit protein in rat renal cortex were determined.The renal structure and cortical echogenicity were observed by ultrasound.The kidney/spleen echo-intensity ratio(K/S)was calculated.In addition,normal control subjects(n=44)and HUA patients(n=46)who received kidney ultrasound examination in Huadong Hospital Affiliated to Fudan University were clinically recruited.Their basic clinical information was collected and compared.Results The results of animal experiments showed that compared with the Cont group,Sua level of the HUA group increased(P<0.05),while NKA activity decreased(P<0.05).Compared with the HUA group,Sua level of the HUA+Feb group decreased(P<0.05),NKA activity and NKA-α1 protein expression increased(P<0.05).The ultrasound results showed that the renal cortical echogenicity of the HUA group was higher than that of the Cont group(P<0.05).After 4 weeks of treatment with febuxostat,the renal cortical echogenicity of the HUA+Feb group significantly improved(P<0.05),and the K/S ratio was lower than that of the HUA group(P<0.05).There were no significant differences in renal length,width and renal parenchymal thickness among all groups(P>0.05).The clinical data showed that HUA patients exhibited enhanced renal cortical echogenicity,increased crystallization and unclear st

关 键 词：高尿酸血症(HUA) 钠钾ATP酶(NKA) 超声 

分 类 号：R589.7[医药卫生—内分泌]