尿视黄醇结合蛋白在诊断早期糖尿病肾病中的评价

目的：探讨尿视黄醇结合蛋白（ＲＢＰ）在糖尿病肾病中的诊断价值。方法：非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者５０例，正常对照组２５例。分别检测尿ＲＢＰ、Ａｌｂ、ＴＲＦ、β２－ｍ、ＮＡＧ和Ｃｒ。结果：ＮＩＤＤＭ组尿ＲＢＰ／Ｃｒ较对照组显著增高，尿ＲＢＰ／Ｃｒ与尿Ａｌｂ／Ｃｒ、ＴＲＦ／Ｃｒ、β２－ｍ／Ｃｒ、ＮＡＧ／Ｃｒ均呈显著性正相关。当尿Ａｌｂ／Ｃｒ在正常范围时，尿ＲＢＰ／Ｃｒ显著增高（Ｐ＜０．０５）。结论：尿ＲＢＰ／Ｃｒ可反映糖尿病早期肾小管损害，可作为诊断早期糖尿病肾病的敏感指标。     

镉接触工人尿NAG活性与其他肾损害指标的相关性研究

本研究采用配对设计的方法，对接触组和对照组人员分别测定了血和尿中镉、钙和β２－微球蛋白（β２－ＭＧ）含量，并测定尿Ｎ－乙酰－β－Ｄ－氨基葡萄糖苷酶（ＮＡＧ）活性和总蛋白含量。结果显示，接触组尿镉、钙、β２－ＭＧ、总蛋白含量和ＮＡＧ活性及血镉含量都高于对照组。尿ＮＡＧ活性与血和尿中镉、钙、β２－ＭＧ和总蛋白含量均呈正相关，表明尿ＮＡＧ是监测镉引起肾损害的敏感指标之一。     

尿γ－GT与尿NAG在铬性肾损害中意义的研究

调查了９８名铬接触工人，发现尿γ－ＧＴ活性与工龄和尿铬呈明显平行关系，另外与尿蛋白和尿β２－ＭＧ呈显著正相关（Ｐ＜０．０１）。当受检者尿蛋白和尿β２－ＭＧ均正常时，尿γ－ＧＴ已显著高于对照组，并随肾损害程度加重而明显增加。但尿ＮＡＧ仅在尿β２－ＭＧ和尿蛋白均异常时显著高于对照组；尿ＮＡＧ与尿蛋白呈显著正相关（Ｐ＜０．０５）。这提示尿γ－ＧＴ可作为铬性肾损害较灵敏的早期检测指标，结合尿ＮＡＧ水平可初步判断铬性肾损害的程度。     

糖尿病肾病血清α１ 微球蛋白和β２ 微球蛋白 联合尿视黄醇结合蛋白检测价值研究

摘要：探讨血清α１ 微球蛋白（α１ ＭＧ）、β２ 微球蛋白（β２ ＭＧ）联合尿视黄醇结合蛋白（ＵＲＢＰ）检测在糖 尿病肾病肾损伤早期诊断的应用价值。选取２０１６年１月至２０１７年１月，宜宾市南溪区中医医院门诊和住 院收治的２型糖尿病患者１６５例为观察组，尿微量白蛋白排泄率（ＵＡＥＲ）＜３０ｍｇ／２４ｈ纳入单纯糖尿病 组，ＵＡＥＲ３０ｍｇ／２４ｈ～３００ｍｇ／２４ｈ纳入早期糖尿病肾病组。随机选取同期该院体检中心健康人群８５例为 对照组。比较各组检测α１ ＭＧ、β２ ＭＧ 和ＵＲＢＰ 水平。结果显示，对照组α１ ＭＧ、β２ ＭＧ 和ＵＲＢＰ 水平 低于单纯糖尿病组，差异有统计学意义（狋＝４．５８８、５．２８４、６．６０４，犘＜０．０５）。单纯糖尿病组α１ ＭＧ、β２ ＭＧ、ＵＲＢＰ和ＵＡＥＲ 水平均低于早期糖尿病肾病组，差异有统计学意义（狋＝１１．５２７、２０．５５１、４５．２５１、 ３５．２５７，犘＜０．０５）。三项指标联合检测对早期糖尿病肾病患者肾损伤预后评估的敏感性为９０．１２％、阳性 预测值为８８．８９％、阴性预测值为７９．０１％，均高于三项指标单独检测，但联合检测的特异性６９．１４％ 低于 三项指标单独检测。α１ ＭＧ、β２ ＭＧ 和ＵＲＢＰ联合检测可提高糖尿病肾病肾损伤早期的诊断率。 关键词：糖尿病肾病；α１ 微球蛋白；β２ 微球蛋白；尿视黄醇结合蛋白 中图分类号：Ｒ５８７．２　　文献标识码：Ｂ　　文章编号：１００９ ６６３９ （２０１９）０３ ０２３３ ０３     

铬作业工人尿NAG同功酶活性变化的探讨

本文调查了９８名铬作业工人，发现尿ＮＡＧ－Ｂ明显升高，尿ＮＡＧ－Ａ显著低于对照组，出现ＮＡＧ－Ａ／ＮＡＧ－Ｂ比值倒置（１：４，正常为３：２）。铬作业工人尿ＮＡＧ－Ｂ在尿蛋白和尿β２－ＭＧ均在正常范围时，已开始显著高于对照组，并随肾损害程度加重而明显增加，提示尿ＮＡＧ－Ｂ可能为检测铬性肾损害较灵敏的指标。尿ＮＡＧ－Ａ虽显著低于对照组，但与尿蛋白和尿β２－ＭＧ无明显相关关系（ｒ均小于０．１８，Ｐ＞０．     

低浓度空气汞污染对人群肾功能的影响

为探讨低浓度汞污染对人群健康的影响,测定了污染区及对照区大气汞、饮用水汞;同时对两区居民测定尿汞、发汞、尿β２－微球蛋白（β２－ＭＧ）和尿Ｎ－乙酰－β－Ｄ氨基葡萄糖苷酶（ＮＡＧ）。结果：污染区大气汞浓度明显高于对照区（Ｐ〈０．０１）;两区生活饮用水汞浓度均不超标。污染区人群尿汞及发汞中位数明显高于对照区人群（Ｐ〈０．０１）;污染区人群尿β２－ＭＧ和尿ＮＡＧ几何均值亦明显高于对照区人群（Ｐ〈０．０１     

慢性镉中毒性肾病的早期诊断

对８８名镉作业工人作了尿、血镉、尿总蛋白（ＴＰ）、尿白蛋白（Ａｌｂ）、尿β２－微球蛋白（β２－ＭＧ）、尿Ｎ－乙酰－β－Ｄ－葡萄糖苷酶（ＮＡＧ）和血清β２－ＭＧ进行了测定。结果明显,尿除与血清β２－ＭＧ不相关外,与其他指标均密切相关提示测定尿β２－ＭＧ、ＮＡＧ对慢性镉中毒性肾病的早期诊断有重要意义。     

二氧化硅粉尘对接触工人的肾毒性研究

通过测定二氧化硅粉尘接触工人和矽肺病人尿白蛋白（ａｌｂ）、β＿２－微球蛋白（β＿２－ＭＧ）和Ｎ－乙酰－β－Ｄ－氨基葡萄糖苷酶（ＮＡＧ）排出量，来确定肾毒性与二氧化硅粉尘接触的关系。结果表明：接尘工人和矽肺病人尿ａｌｂ、β＿２－ＭＧ和ＮＡＧ排出量显著高于对照组，其排出量增加与接尘工人接尘时间有关，而与矽肺病人脱离接尘的时间无关。证实二氧化硅粉尘可导致接触者出现慢性、非可逆性肾毒性反应。     

镉接触工人尿NAG活性与其它肾损害指标的相关性研究

本研究采用配对设计的方法，对接触组和对照组人员分别测定了血和尿中隔、钙和β２－微球蛋白（β２－ＭＧ）含量，并测定尿Ｎ－乙酰－β－Ｄ－氨基葡萄糖苷酶（ＮＡＧ）活性和总蛋白含量均呈相相关，表明尿ＮＡＧ是监测镉引起肾损害的敏感指标之一。     

慢性镉接触者肾损伤早期诊断指标的评价

选择尿酶Ｎ－乙酰－β－Ｄ－葡萄糖苷酶（ＮＡＧ）、γ－谷胺酰转肽酶（γ－ＧＴ）、尿镉（Ｃｄ）、尿低分子蛋白（β２－ＭＧ）、尿总蛋白（ＴＰ）、尿钙（Ｃａ）为检测项目，分析、评价其作为镉致肾损伤早期效应指标的实用价值。研究表明尿ＮＡＧ和尿Ｃｄ有明显的剂量－反应关系。当尿Ｃｄ在０．０５μｍｏｌ／Ｌ（５μｇ／Ｌ）时尿ＮＡＧ异常率增高，其反应比β２－ＭＧ敏感，表明肾小管细胞损伤先于功能损伤。因此，推荐二联指标尿Ｃｄ＋ＮＡＧ作为镉致肾损伤早期筛检指标。三联指标Ｃｄ＋ＮＡＧ＋β２－ＭＧ特异度高、误诊率低，作为镉致肾损伤早期诊断指标较为合理。     

多项指标联合检测对糖尿病早期肾损害的诊断价值

目的探讨联合检测尿液视黄醇结合蛋白(RBP)、ɑ1-微球蛋白(ɑ1-MG)、微量白蛋白(MA)、N-乙酰-β-D氨基葡萄糖苷酶(NAG)和血清半胱氨酸蛋白酶抑制剂C(CysC)在糖尿病早期肾损害诊断中的价值。方法对68例糖尿病早期肾损害患者和30例健康人标本的尿液RBP、ɑ1-MG、MA、NAG和血清CysC进行测定,并分析单项指标及五项指标联合检测对糖尿病早期肾损害的诊断价值。结果 尿液RBP、ɑ1-MG、MA、NAG和血清CysC在糖尿病早期肾损害患者中均有不同程度增高,与正常对照比较均有显著性差异(p<0.05),五项指标联合检测可显著提高糖尿病早期肾损害的诊断效率(92.1%)。结论尿液RBP、ɑ1-MG、MA、NAG和血清CysC是诊断糖尿病早期肾损害的敏感指标。     

镉污染区人群尿NAG同功酶水平的探讨

为探讨镉污染区人群尿ＮＡＧ同功酶水平，对不同程度镉污染区人群进行肾功能情况调查及其尿ＮＡＧ同功酶水平测定，同时取无镉污染区人群为对照。结果发现：镉污染区人群尿ＮＡＧ同功酶的排泄均显著高地对对照组具有统计学意义，尤以ＮＡＧ－Ｂ明显，镉污染区人群即使无肾损伤时，其尿中ＮＡＧ，ＮＡＧ－Ｂ排泄均显著高于对照组；同时发现尿ＮＡＧ、ＮＡＧ－Ｂ阳性率发生与尿镉的排泄呈明显剂量－反应关系，以ＮＡＧ－Ｂ较为突出，提     

Effects of elemental mercury exposure at a thermometer plant

This study compares 84 mercury-exposed workers at a thermometer manufacturing facility with 79 unexposed workers for evidence of chronic mercury toxicity. Personal breathing-zone air concentrations of mercury ranged from 25.6 to 270.6 micrograms/m3 for thermometer workers. Urinary mercury levels in the study population ranged from 1.3 to 344.5 micrograms/g creatinine, with eight (10%) participants exceeding 150 micrograms/g creatinine and three workers exceeding 300 micrograms/g creatinine, which indicates increased absorption of mercury among the thermometer workers. All urine mercury levels in the comparison group were compatible with normal background levels in unexposed adults (less than 10 micrograms/g creatinine). Thermometer plant workers reported more symptoms than did controls; in general, these differences were not statistically significant and could not be specifically associated with mercury exposure. Static tremor, abnormal Romberg test, dysdiadochokinesia, and difficulty with heel-to-toe gait were more prevalent among thermometer workers than control workers, which could not be associated with recent mercury exposure; there was some suggestion of an association with chronic exposure. There were no intergroup differences for the standard clinical tests of renal function except for a significantly higher mean specific gravity among the thermometer workers. A positive correlation was found, however, between urinary N-acetyl-b-D-glucosaminidase (NAG) and urinary mercury. There was no consistent evidence for intergroup differences in proximal renal tubule function, as measured by urinary beta 2-microglobulin (B2M) or retinol binding protein (RBP).     

Assessment of urinary protein 1 and transferrin as early markers of cadmium nephrotoxicity.

Transferrin and protein 1, a sex linked alpha 2-microprotein, were assayed in urine from 58 workers exposed to cadmium (Cd) in a non-ferrous smelter and from 58 age matched referents. These two new markers of nephrotoxicity were compared with urinary beta 2-microglobulin (beta 2-m), retinol binding protein (RBP), albumin, and beta-N-acetyl-glucosaminidase (NAG). The response of protein 1 to Cd tubulotoxicity was similar to that of beta 2-m, RBP, and NAG. In Cd workers, protein 1 had a correlation with urinary Cd (r = 0.56) similar to beta 2-m (r = 0.48), RBP (r = 0.58), and NAG (r = 0.49). Values of these three low molecular weight proteins and of NAG were increased only in workers with urinary Cd higher than 10 micrograms/g creatinine. Urinary transferrin and albumin were similarly affected by exposure to Cd. Their response, however, was clearly more sensitive than that of low molecular weight proteins. Prevalences of positive values of these two high molecular weight proteins were not only higher but also tended to rise at lower concentrations of Cd in urine or blood. This finding suggests that in some subjects subtle defects in glomerular barrier function may precede the onset of proximal tubular impairment after chronic exposure to Cd. It remains to be assessed whether these subjects are more at risk of developing renal insufficiency.     

Assessment of urinary protein 1 and transferrin as early markers of cadmium nephrotoxicity

Transferrin and protein 1, a sex linked alpha 2-microprotein, were assayed in urine from 58 workers exposed to cadmium (Cd) in a non-ferrous smelter and from 58 age matched referents. These two new markers of nephrotoxicity were compared with urinary beta 2-microglobulin (beta 2-m), retinol binding protein (RBP), albumin, and beta-N-acetyl-glucosaminidase (NAG). The response of protein 1 to Cd tubulotoxicity was similar to that of beta 2-m, RBP, and NAG. In Cd workers, protein 1 had a correlation with urinary Cd (r = 0.56) similar to beta 2-m (r = 0.48), RBP (r = 0.58), and NAG (r = 0.49). Values of these three low molecular weight proteins and of NAG were increased only in workers with urinary Cd higher than 10 micrograms/g creatinine. Urinary transferrin and albumin were similarly affected by exposure to Cd. Their response, however, was clearly more sensitive than that of low molecular weight proteins. Prevalences of positive values of these two high molecular weight proteins were not only higher but also tended to rise at lower concentrations of Cd in urine or blood. This finding suggests that in some subjects subtle defects in glomerular barrier function may precede the onset of proximal tubular impairment after chronic exposure to Cd. It remains to be assessed whether these subjects are more at risk of developing renal insufficiency.     

难治性肾病肾小管功能损害及缬沙坦干预研究

目的探讨肾小管功能损害在难治性肾病（RNS）中的意义及缬沙坦干预治疗对其影响。方法RNS患者阳例及正常对照68例，79例RNS患者随机分为缬沙坦组和潘生丁组，在常规治疗的基础上，缬沙坦组加缬沙坦（80mg／d），潘生丁组加潘生丁（150mg／d）治疗12周。治疗前后采用ELISA法、生化方法及肾间质病理计量分析法分别检测全部患者肾小管功能（尿RBP、α1-MG、β2-MG、mAlb、NAG）和肾间质病理改变。结果所有RNS患者尿RBP、α1-MG、β2-MG、mAlb、NAG明显高于正常对照组（P〈0．01）。且与肾小管间质损害均呈正相关（r=0．436、0．626、0．499、0．668、0．657，P〈0．01）。干预结果显示缬沙坦组口服缬沙坦后尿系列蛋白均明显降低，而潘生丁组则无明显变化。结论RNS患者均有不同程度的肾间质损害及肾小管功能的损害，而肾小管功能损害与肾间质损害及肾小球损害程度呈正相关。及早对RNS进行ARB干预治疗可改善肾小管功能及延缓RNS的发展。     

尿微量蛋白联合尿酶对高血压早期肾损害的诊断价值

目的探讨高血压早期肾损害的诊断标准。方法对50名健康者（对照组）和50例高血压患者（试验组）采用免疫散射比浊法检测尿转铁蛋白（TRF），终点法测微量白蛋白（mALB），免疫透射比浊法测定尿视黄醇结合蛋白（RBP），速率法测定尿N-乙酰氨基葡萄糖苷酶（NAG），酶法测定尿肌酐（Cr）。比较两组实验室指标结果。结果对照组：尿TRF／Cr为0．05±0．03mg／mmol，mALB为3．61±2．46mg／L，RBP／Cr为7．46±5．02ug／mmol，NAG／Cr为0．52±0．46U／mmol。试验组的TRF／Cr、mALB、RBP／Cr和NAG／Cr值较对照组的增高有统计学意义（P＜0．01）；两项指标联合检测，其阳性率分别为：TRF＋mALB：62％，TRF＋NAG：54％，mALB＋NAG：44％，TRF、mALB和NAG3项指标联合检测可使阳性率提高到78％，大大提高了阳性检出率。结论联合检测尿TRF、mALB及NAG是诊断高血压早期肾损害较灵敏的实验室指标。     

职业接触汞工人肾脏早期损伤指标的探讨

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。     

Long-term effects of elemental mercury on renal function in miners of the Idrija Mercury Mine

BACKGROUND: The kidneys are one of the main target organs for elemental mercury (Hg(0)). The influence of Hg(0) on kidneys has been extensively studied but the long-term effects on this organ have not yet been determined with certainty. The basic aim of this research was to study the effects of a long-term exposure to Hg(0) vapours on the renal function in miners in the post-exposure period. METHODS: The population studied comprised 53 miners (33 active and 20 retired) from the Idrija Mercury Mine as the exposed miners group and 53 unexposed workers as the control group. On the basis of mine exposure records (air and biological monitoring), the environmental and biological indicators of the past exposure to Hg(0) were calculated for each miner. Kidney function was determined in both groups, i.e. in the exposed miners as well as in the controls. Glomerular kidney function was evaluated by a quantitative analysis of albumin and IgG in urine. Tubular kidney function, however, was determined by a quantitative analysis of alpha(1)-microglobulin in urine and by the enzymatic activity of N-acetyl-beta-d-glucosaminidase (NAG). RESULTS: The mean exposure time in miners was 15 years. The total number of cycles of exposure ranged from 13 to 119. The mean annual time-weighted exposure was 0.29 mg m(-3) and the mean integrated exposure intensity (IEI) was 1413 mg m(-3)-h. Throughout the period of exposure the average urine mercury concentration in miners was 68.24 microg l(-1) and the average sum of peak urine mercury concentrations was 3901 microg l(-1). Albumin, IgG and alpha(1)-microglobulin in urine were significantly elevated in the exposed miners compared with the unexposed controls (t = 2.17, P = 0.03; t = 2.81, P < 0.01; and t = 2.07, P = 0.04). No significant differences were found in the urine NAG activity when the exposed miners and the unexposed workers were compared. Among the indicators of renal function only alpha(1)-microglobulin in the urine correlated significantly with the IEI (r = 0.73; P 相似文献   

The effects of environmental cadmium exposure on kidney function: the possible influence of age

The study aimed to assess the possible influence of long-term environmental exposure to cadmium and age at the time of exposure on renal function. The study was a follow-up of the 1991-1994 project concerning 2000 inhabitants of a cadmium-contaminated area in the vicinity of a zinc smelter. Since the smelter was built in the late 1950s but was not operated until 1968, some of the inhabitants were not exposed to cadmium during childhood. For the follow-up, 308 persons who in 1993 presented with Cd-U levels > or = 0.5 microg/L adjusted for specific gravity (1.020) were selected in 2000. The study population included 136 people who were exposed to cadmium in childhood (former children) and 172 adults (unexposed adults) with no such exposure. These two groups were divided into subgroups according to Cd-U levels: < or =1 (group 1), 1-2 (group 2), and > or =2 microg/g creatinine (group 3). Urinary and blood cadmium and the markers of renal tubular dysfunction (beta2 M-U, RBP-U, NAG, NAG-A, NAG-B) and glomerular dysfunction (Alb-U and beta2 M-S) were measured. Persons with a history of occupational exposure to cadmium were excluded from this project. In group 3 of the unexposed adults, concentrations of RPB-U, NAG, NAG-B, and Alb-U were significantly higher than those in group 1. In former children, this could be observed only for RPB-U and Alb-U. Urine concentrations of these markers were higher in all of the subgroups of former children than in the groups of unexposed adults (except for NAG and its two forms). However, these differences were significant only for RBP-U in group 3. The findings indicate that early renal effects in the general population may occur at Cd-U concentrations above 2 microg/g creatinine and at lower levels for NAG-B. Moreover, cadmium exposure in childhood may have a stronger impact the renal function, particularly tubular reabsorption, than the exposure of a mature organism.