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目的 探讨职业接触汞工人肾损伤的早期监控指标。方法 尿汞 (HgU)采用二硫腙化学法测定 ,尿视黄醇结合蛋白 (RBP)、尿 β2 微球蛋白 (β2 MG)和尿微量白蛋白 (mALB)采用全定量酶免疫法测定 ,尿N 乙酰 β D 氨基葡萄糖苷酶 (NAG)和γ 谷氨酰基转移酶 (γ GT)采用速率法测定 ,尿肌酐(Cr)采用苦味酸法测定。结果 职业接触汞工人尿RBP、β2 MG、NAG、γ GT测定结果分别为 (4 39.7±2 0 1.4 )、(14 1.4± 5 6 .3) μg gCr,(12 .3± 5 .7)、(6 0 .3± 18.5 )U gCr,均高于对照组 [分别为 (2 4 3.2±16 9.1)、(88.6± 4 1.2 ) μg gCr,(8.2± 1.6 )、(4 1.3± 13.2 )U gCr],差异均有显著性 (P <0 .0 5 ,P <0 .0 1)。随尿汞含量增加上述指标有逐渐增高的趋势 ;单项及两项检测RBP、β2 MG、NAG、γ GT的阳性率较低 ,联合其中 3项检测阳性率较高 ,联合 4项检测阳性率可达 85 .5 %。结论 联合检测RBP、β2 MG、NAG、γ GT是诊断职业接触汞工人早期肾损伤的灵敏指标。
Objective To investigate the early monitoring indicators of renal injury in workers exposed to mercury. Methods Urinary mercury (HgU) was determined by dithizone chemistry method. Urinary retinol binding protein (RBP), urinary β2 microglobulin (β2 MG) and urinary microalbumin (mALB) were measured by enzyme-linked immunosorbent assay N-acetyl-D-glucosaminidase (NAG) and gamma-glutamyl transferase (γ-GT) were determined by the rate method. Urinary creatinine (Cr) was measured by picric acid method. Results The results of urinary RBP, β2 MG, NAG and γ GT in workers exposed to mercury were (4 39.7 ± 20.4), (14 1.4 ± 56.3) μg gCr, (12.3 ± 5 .7), (6 ± 0.3 ± 18.5) U gCr were higher than those in the control group [(24.2 ± 16.91), (88.6 ± 4.12) μg gCr, (8.2 ± 1.6), (4.13 ± 13.2) U gCr], the differences were significant (P <0.05, P <0.01). With the increase of urinary mercury content, the above indexes had a trend of increasing gradually. The positive rates of RBP, β2 MG, NAG and γ GT were lower in single and two tests, and the positive rates of three tests were higher. Up to 85.5%. Conclusions Combined detection of RBP, β2 MG, NAG and γ GT is a sensitive index to diagnose early renal injury in workers exposed to mercury.