CAJ | 학술논문

目的：探讨尿液中肾损伤分子－1（KIM －1）和中性粒细胞明胶酶相关载脂蛋白（NGAL）对高血压肾损害的诊断价值。方法选择原发性高血压患者68例，根据尿白蛋白／肌酐（Cr）比值（UACR）分为正常白蛋白尿组（NA 组）19例、微量白蛋白尿组（MA 组）24例、临床蛋白尿组（CA 组）22例；同期选取14例健康人做正常对照（对照组）。检测血 Cr、尿白蛋白、尿 Cr，计算 UACR；根据 MDRD 公式计算肾小球滤过率（eGFR）；监测血压，计算平均动脉压（MAP）；采用 ELISA 法检测各组尿 KIM －1和 NGAL，尿 NGAL 和 KIM －1的检测结果除以尿 Cr 作为最后结果，以纠正尿液浓度对结果测定的影响。结果高血压各组的 eGFR、MAP 随蛋白尿增加而逐渐升高，组间比较差异均有统计学意义（P ＜0.05），但 NA 组 eGFR 与对照组比较差异无统计学意义；尿 NGAL／Cr 和尿 KIM －1／Cr 随着蛋白尿的增加而逐渐升高，各组间比较差异均有统计学意义（P ＜0.05）；在相关性分析中，尿 NGAL／Cr与 UACR 和 MAP 呈正相关，与 eGFR 呈负相关，而尿 KIM －1／Cr 与 UACR 呈正相关，与 eGFR 呈负相关，与 MAP 无关。结论尿 KIM －1在高血压蛋白尿出现之前的早期肾损伤具有一定的预测价值，而 NGAL 不但可作为早期高血压肾损害的诊断指标，而且还能协助评估血压控制情况，推测其对高血压其他脏器损害也有预测价值。
목적：탐토뇨액중신손상분자－1（KIM －1）화중성립세포명효매상관재지단백（NGAL）대고혈압신손해적진단개치。방법선택원발성고혈압환자68례，근거뇨백단백／기항（Cr）비치（UACR）분위정상백단백뇨조（NA 조）19례、미량백단백뇨조（MA 조）24례、림상단백뇨조（CA 조）22례；동기선취14례건강인주정상대조（대조조）。검측혈 Cr、뇨백단백、뇨 Cr，계산 UACR；근거 MDRD 공식계산신소구려과솔（eGFR）；감측혈압，계산평균동맥압（MAP）；채용 ELISA 법검측각조뇨 KIM －1화 NGAL，뇨 NGAL 화 KIM －1적검측결과제이뇨 Cr 작위최후결과，이규정뇨액농도대결과측정적영향。결과고혈압각조적 eGFR、MAP 수단백뇨증가이축점승고，조간비교차이균유통계학의의（P ＜0.05），단 NA 조 eGFR 여대조조비교차이무통계학의의；뇨 NGAL／Cr 화뇨 KIM －1／Cr 수착단백뇨적증가이축점승고，각조간비교차이균유통계학의의（P ＜0.05）；재상관성분석중，뇨 NGAL／Cr여 UACR 화 MAP 정정상관，여 eGFR 정부상관，이뇨 KIM －1／Cr 여 UACR 정정상관，여 eGFR 정부상관，여 MAP 무관。결론뇨 KIM －1재고혈압단백뇨출현지전적조기신손상구유일정적예측개치，이 NGAL 불단가작위조기고혈압신손해적진단지표，이차환능협조평고혈압공제정황，추측기대고혈압기타장기손해야유예측개치。
Objective To investigate the expression and significance of urine kidney injury molecule -1 (KIM -1) and neutrophil gelatinases associated lipocalin (NGAL) in hypertensive renal damage with different degree of albumi -nuria.Methods Sixty -eight patients with primary hypertension were selected .According to the urinary albumin /creati-nine ratio (ACR), they were divided into normal albuminuria group (NA, n =19), microalbuminuria group (MA, n =24), and clinical albuminuria group (CA, n =22).Fourteen healthy persons were enrolled as normal controls .Serum creatinine, urine creatinine and urine albumin were recorded for calculation of ACR .According to MDRD formula, GFR was also calculated.Blood pressure was monitored and the mean arterial pressure (MAP) was calculate.By ELISA meth-od, urine NGAL and KIM -1 were assessed, and the test results were presented with urine NGAL and KIM -1 divided by urine creatinine as the final results .Results The levels of eGFR and MAP were significantly increased with the increase of proteinuria in each hypertension groups , there was statistical significance among the 3 groups (P <0.05); but there was no significant difference in eGFR between NA group and normal control group .Urine NGAL/Cr and KIM -1 /Cr were increased with the increase of proteinuria in each hypertension groups , there was statistical significance among the 3 groups (P <0.05).In correlation analysis, the urine NGAL /Cr was positively correlated with ACR and MAP, negatively correla-ted with eGFR; the urine KIM -1/Cr was positively correlated with ACR and negatively correlated with eGFR .Conclu-sion The urine NGAL and KIM -1 may be useful to assess early hypertensive kidney injury prior to microalbuminuria . Moreover, NGAL can evaluate the blood pressure control , with predictive value on the hypertension -induced damage of other organs.