慢性阻塞性肺疾病急性加重期患者早期肾功能损害相关分析

目的分析探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者早期肾功能损害指标,并作相关性分析。方法共募集AECOPD患者76例,健康体检人群30例;收集一般临床资料;进行血肌酐、尿素氮、C反应蛋白(CRP)、动脉血气、尿α_1-微球蛋白(α-MG)、尿β_2-微球蛋白(β_2-MG)测定;及肺功能检查。结果与对照组比较,AECOPD组患者血肌酐、尿素氮及肾小球滤过率差异无统计学意义(P0.05);而尿α_1-MG、尿β_2-MG显著升高(P0.05),其中尿α_1-微球蛋白与氧分压(PaO_2)、FEV_1%及FVC%呈负相关,与CRP呈正相关;尿β_2-微球蛋白与FEV_1%、FVC%及FEV_1/FVC呈负相关。按GOLD 2013年指南肺功能分级进一步亚组分析显示,伴随肺功能严重程度的加重,AECOPD组患者尿α_1-微球蛋白、尿β_2-微球蛋白显著高于对照组,差异有统计学意义(P0.05)。此外,依指南予以正规内科治疗后,AECOPD组肺功能及CRP指标较前改善,血清CRP、尿α_1-微球蛋白、尿β_2-微球蛋白均较前改善,但仍高于正常对照组,差异有统计学意义(P0.05)。结论 AECOPD患者存在早期肾功能损害,尿α_1-微球蛋白、尿β_2-微球蛋白可作为早期肾功能损害指标。对于急性加重期患者,加强尿α_1-MG、尿β_2-MG的监测可及早发现早期肾功能损害,正规的内科治疗可进行有效干预,从而避免肾功能不可逆性损害的发生。

Analysis of early renal injury in patients with AECOPD

Objective To analyze the related causes of early renal injury in patients with AECOPD. Meth-ods The study sellected 76 patients with AECOPD as the experiment group and 30 health examination people as the control grou, and their. clinical data were collected. Their serum creatinine, blood urea nitrogen, C-creative protein (CRP), arterial blood gas, urine α1-microglobulin (α-MG) and β2-microglobulin (β2-MG) were measured, and they were also given pulmonary function tests. Results There was no significant difference in serum creatinine, urea nitrogen and glomerular filtration rate between the two groups ( P>0. 05 ) , but the levels of urine α1-MG and urineβ2-MG were obviously higher in the AECOPD group than in the control group ( P<0. 05 ) . Urine α1-microglobulin was negatively correlated with oxygen partial pressure ( PO2 ) , FEV1% and FVC%, and it was positively correlated with CRP, while urineβ2-microglobulin was negatively correlated with FEV1%, FVC% and FEV1/FVC. According to the GOLD2013 guidance, the analysis of further subgroups showed that as the level of pulmonary function increased significantly, the levels of urineα1-MG and urineβ2-MG were significantly higher than those in the control group ( P<0. 05). Conclusion There exsits early renal damage in AECOPD patients, and urine α1-microglobulin and β2-microglobulin could be taken as the early indicators of renal damage. For AECOPD patients, the monitoring of urinaryα1-MG and urinaryβ2-MG can reflect the early renal function damage and give related interventions, in order to avoid the occurrence of irreversible renal function damage.