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目的:对海拔高度3 300m(刚察县)高原红细胞增多症(HAPC)患者尿白蛋白(ALB)和N-乙酰-β-D-氨基葡糖苷酶(NAG)的排泄变化进行了观察并探讨了可能的机制变化。方法:对海拔高度3 300m HAPC患者38例和健康人115例分别采用尿蛋白酶标免疫法、邻苯三酚自氧化法、TBA和酶法检测了尿ALB、NAG、红细胞滤过指数(EFl)、红细胞超氧化物歧化酶(SOD)活性和血浆丙二醛(MDA)含量。结果:HAPC患者尿ALB、NAG、血浆MDA含量和EFI明显高于同海拔健康组,而红细胞SOD活性明显低于同海拔健康组;相关和多因素逐步回归分析表明,尿ALB和NAG与EFI呈正相关,而与血浆MDA含量、红细胞SOD、血红蛋白、红细胞、红细胞压积水平无明显相关。结论:红细胞变形能力(ED)对尿ALB和NAG存在独立影响,HAPC患者机体脂质过氧化反应增强,可能导致ED降低,造成肾内微循环障碍,可能是尿ALB和NAG含量产生增多的病理生理机制之一。
Objective: To investigate the changes of urinary albumin (ALB) and N-acetyl-β-D-glucosaminidase (NAG) excretion in patients with altitude polycythemia (HAPC) at a height of 3 300 m (Gangcha County) Possible mechanism changes. Methods: Urinary ALB, NAG, erythrocyte filtration index (EFl) and urinary albumin (ALB) were detected by urine protease immunoassay, pyrogallol autooxidation method, TBA and enzymatic method respectively in 38 cases of HAPC patients with altitude of 300 m and healthy subjects. , Erythrocyte superoxide dismutase (SOD) activity and plasma malondialdehyde (MDA) content. Results: The levels of urine ALB, NAG, plasma MDA and EFI in HAPC patients were significantly higher than those in the same elevation group, while the activities of SOD in erythrocytes were lower than those in the same elevation group. The correlation and multi-factor stepwise regression analysis showed that urine ALB and NAG were positively correlated with EFI , But not with plasma MDA level, erythrocyte SOD, hemoglobin, erythrocyte and hematocrit levels. CONCLUSION: Erythrocyte deformability (ED) has an independent effect on urinary ALB and NAG. Hypertrophic lipid peroxidation in HAPC patients may result in reduction of ED and microcirculation in the kidney, which may be caused by the increase of urine ALB and NAG content One of the physiological mechanisms.