原发性高血压患者肾小管间质损伤与肾小球损伤的关系

摘要

目的 探讨原发性高血压患者肾小管间质损伤与肾小球损伤的关系.方法 序贯收集68例原发性高血压患者,根据家庭自测血压控制情况将其分成血压控制达标组及血压控制未达标组,正常对照组26例.用相关实验室方法测定所有研究对象的尿蛋白/尿肌酐比值(ACR)、估算肾小球滤过率(eGFR)、尿中性粒细胞明胶酶相关脂质运载蛋白(μNGAL)及血清光抑素C(Cys C)的水平.结果 血压控制达标组μNGAL比正常对照组显著升高[分别为(3.39±0.58):(1.24±0.51) ng/ml,P=0.009],高血压患者中家庭自测血压控制未达标组μNGAL显著高于控制达标组[分别为(3.87±0.83):(3.39±0.58) ng/ml,P＜0.001].ACR、eGFR、Cys C在高血压组及正常对照组间均无显著差异(P＞0.05),而血压控制未达标组的Cys C高于血压控制达标组[分别为(1.10±0.25):(0.96±0.18) mg/L,P=0.043].μNGAL分别与Cys C(r=0.287,P=0.005)及收缩压(r=0.370,P＜0.001)呈正相关.结论 原发性高血压患者肾损害早期表现为以μNGAL升高的肾小管间质损伤,其发生早于肾小球损伤;μNGAL可作为高血压患者早期肾损害的预测指标.%Objective To investigate the relationship of glomerular and tubulointerstitial injury in patients with primary hypertension.Methods 68 patients with primary hypertension were recruited in this study.They were divided into two groups including a group of blood pressure control and a group of blood pressure out of control based on data of home blood pressure monitoring (HBPM).26 healthy subjects were recruited as control group.Estimated glomerular filtration rate (eGFR),urine albumin/creatinine ratio (ACR),urinal neutrophil gelatinase-associated lipocalin (uNGAL) and cystatin C (Cys C) were determined by relevant laboratory methods in all included individuals.Results Urinal NGAL levels were significantly increased in hypertensive patients with blood pressure control when compared with healthy individuals [(3.39±0.58) VS(1.24±0.51) ng/ml,P=0.009],and uNGAL levels were higher in hypertensive patients with blood pressure out of control group than that in blood pressure control group[(3.87±0.83) VS (3.39±0.58) ng/ml,P＜ 0.001].There was no significant statistical difference between hypertensive group and normal control group on ACR,eGFR and Cys C.However,Cys C levels were higher in blood pressure out of control group than that in blood pressure control group[(1.10±0.25) VS (0.96±-0.18) mg/l,P=0.043].Moreover,uNGAL was positively correlated with Cys C (r=0.287,P=0.005) and systolic pressure (r=0.370,P＜0.001).Conclusion Tubulointerstitial injury is present in the early stage of hypertensive nephropathy and may precede glomerular damage.The increasing uNGAL is clinically significant for the early assessment of hypertensive nephropathy.