高血压早期肾损害诊断指标的筛选  

Screening of diagnostic indicators for early renal damage in patients with hypertension

作　　者：孔德慧 刘敏[1] KONG Dehui;LIU Min(Department of Hypertension,Henan Provincial People′s Hospital,Zhengzhou 450000)

机构地区：[1]河南省人民医院高血压科,郑州450000

出　　处：《郑州大学学报（医学版）》2024年第3期376-380,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学科技攻关计划项目(LHGJ20220002);国家自然科学基金面上项目(82270463)。

摘　　要：目的:筛选高血压早期肾损害的诊断指标。方法:搜集2020年1月至2023年2月河南省人民医院内科病房收治的高血压患者,选取高血压早期肾损害[30 mg/24 h≤尿白蛋白排泄率(uAER)<300 mg/24 h]患者51例(肾损害组),以及单纯高血压患者51例(对照组)。比较两组患者血清尿素氮(BUN)、肌酐(SCr)、同型半胱氨酸(HCY)、视黄醇结合蛋白(RBP)、胱抑素C(CysC)、尿微量白蛋白(umALB)、微量白蛋白/肌酐比值(uACR)、α1微球蛋白(uα1MG)、β2微球蛋白(uβ2MG)、N-乙酰-β-D氨基葡萄糖苷酶(uNAG)及转铁蛋白(uTF)水平的差异。绘制ROC曲线,比较上述指标对高血压早期肾损害的诊断效能。结果:肾损害组患者血清BUN、SCr、HCY、RBP、CysC水平及umALB、uAER、uACR、uα1MG、uβ2MG、uNAG、uTF水平均高于对照组(P均<0.05)。ROC曲线AUC>0.9的指标从高到低分别为uACR>CysC>uα1MG>uβ2MG>umALB>RBP,其中CysC+uACR联合诊断的效能和敏感度最高[AUC(95%CI)为0.994(0.954~1.000),敏感度为1.000]。结论:CysC+uACR为高血压患者早期肾损害的高效诊断指标。Aim:To screen diagnostic index of early renal damage in patients with hypertension.Methods:From January 2020 to February 2023,hypertensive patients admitted to the Department of Internal Medicine of Henan Provincial People′s Hospital were chosen.Fifty-one hupertension patients with early renal damage[30 mg/24 hour≤urinary albumin excretion rate(uAER)<300 mg/24 hour](renal damage group),and 51 patients with simple hypertension(control group)were selected.ROC curve was drawn to compare the diagnostic efficacy of serum urea nitrogen(BUN),serum creatinine(SCr),serum homocysteine(HCY),serum retinol-binding protein(RBP),serum cystatin C(CysC),urinary microalbumin(umALB),urinary microalbumin/creatinine ratio(uACR),urinaryα1 microglobulin(uα1MG),urinaryβ2 microglobulin(uβ2MG),urinary N-acetyl-β-D glucosaminidase(uNAG),and urinary transferrin(uTF).Results:The levels of indexes(BUN,SCr,HCY,RBP,CysC,umALB,uAER,uACR,uα1MG,uβ2MG,uNAG,uTF)in renal damage group were significantly higher than those in control group(all P<0.05);the order of diagnostic efficacy(AUC>0.9)from high to low was as follows:uACR>CysC>uα1MG>uβ2MG>umALB>RBP.Combination of CysC and uACR had the highest diagnostic efficiency[AUC(95%CI)was 0.994(0.954-1.000),sensitivity rate of 1.000].Conclusion:Combination of CysC and uACR has higher diagnostic efficacy of early renal damage in patients with hypertension.

关 键 词：高血压 肾损害 肾功能 24 h尿白蛋白排泄率 血清胱抑素C 尿微量白蛋白/肌酐比值 

分 类 号：R544.1[医药卫生—心血管疾病]