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目的探讨尿微量白蛋白、转铁蛋白、α1-微球蛋白、β2-微球蛋白在SLE患者早期肾损害监测中的意义。方法 SLE患者108例,依据是否有肾脏的临床表现分为两组:有肾脏表现组和无肾脏表现组。65名健康献血者为正常对照组。收集受检者晨起第2次尿液,采用免疫散射比浊法定量检测尿微量白蛋白、转铁蛋白、α1-微球蛋白、β2-微球蛋白。血清尿素氮、肌酐的检测采用全自动生化仪(东芝120)检测。结果有肾脏表现组4种微量蛋白均高于无肾脏表现组和对照组(P<0.05),无肾脏表现组4种微量蛋白均高于对照组(P<0.05)。4项指标单独检测的阳性率在无肾脏表现组、有肾脏表现组组内比较,差异均无统计学意义(P>0.05)。而分析4种微量蛋白联合检测阳性率的结果,发现在无肾脏表现组1项指标阳性率与2项指标阳性率比较,3项指标阳性率与4项指标阳性率比较,差异无统计学意义(P1,2;P3,4>0.05)。而1项指标阳性率与3项指标阳性率比较,与4项指标阳性率比较;2项指标阳性率与3项指标阳性率比较,与4项指标阳性率比较,差异有统计学意义(P1,3;P1,4;P2,3;P2,4<0.05)。在有肾脏表现组结果与无肾脏表现组结果相同。有肾脏表现患者的尿中微量白蛋白、转铁蛋白、α1-微球蛋白、β2-微球蛋白与血清尿素氮之间无统计学相关性;尿中转铁蛋白、α1-微球蛋白、β2-微球蛋白与血清肌酐之间无统计学相关性,P>0.05;而尿微量白蛋白与血清肌酐之间呈正相关,r=0.737,P<0.05。结论 4种指标联合检测可以大大提高阳性检出率,提示系统性红斑狼疮患者早期动态观察监测尿微量蛋白的类型与含量,对患者肾早期损伤的诊断具有非常重要的临床价值。
Objective To investigate the significance of urinary albumin, transferrin, α1-microglobulin and β2-microglobulin in the monitoring of early renal damage in patients with SLE. Methods One hundred and eight patients with SLE were divided into two groups based on the clinical manifestations of the kidneys: renal manifestations and no kidney manifestations. The 65 healthy blood donors were normal control group. Subjects were collected from the morning of the second urine, the use of immune nephelometry urinary albumin, transferrin, α1-microglobulin, β2-microglobulin. Serum urea nitrogen, creatinine detection using automatic biochemical analyzer (Toshiba 120) test. Results There were 4 kinds of trace proteins in the kidney expression group were higher than those in the no kidney group and the control group (P <0.05), and those in the group without kidney expression were higher than those in the control group (P <0.05). There was no significant difference in the positive rates of the four indexes in the group without renal manifestations and in the group with renal manifestations (P> 0.05). However, the results of the combined detection of four kinds of microproteins showed no significant difference between the positive rate of the three indicators and the positive rate of the four indicators in the group without renal manifestations compared with the positive rate of the two indicators (P1,2; P3,4> 0.05). The positive rate of one index was compared with the positive rate of three indexes, and the positive rate of four indexes was compared with the positive rate of four indexes. The positive rate of two indexes was compared with the positive rate of three indexes , 3; P1,4; P2,3; P2,4 <0.05). In the group with kidney performance results and no kidney performance group the same results. Urinary microalbumin, transferrin, α1-microglobulin, β2-microglobulin and serum urea nitrogen in patients with renal manifestations had no statistical correlation; urinary transferrin, α1-microglobulin, β2 There was no significant correlation between microglobulin and serum creatinine (P> 0.05). There was a positive correlation between urinary albumin and serum creatinine (r = 0.737, P <0.05). Conclusion The combined detection of 4 indexes can greatly increase the positive detection rate, suggesting that early dynamic observation of systemic urinary protein in patients with systemic lupus erythematosus to monitor the type and content of urine microalbumin has important clinical value in the diagnosis of early renal injury in patients.