摘要
目的：探讨尿微量蛋白在高血压早期肾损害诊断及评价益肾平肝汤临床疗效的应用价值。方法：选择医院2015年1月—2016年10月收治的200例原发性高血压患者作为研究对象,所有患者入院后取晨尿20 mL进行尿微量清蛋白（mALb）、尿β2-微球蛋白（β2-MG）,抽取静脉血3mL进行血β2-MG、血尿素氮（BUN）、血肌酐（Cr）检测,比较尿联检与各单项指标检测阳性率差异。将尿联检阳性者按随机数字表分为观察组和对照组,对照组进行常规基础治疗,观察组在对照组的基础上再口服益肾平肝汤治疗,30 d为1个疗程,连续治疗2个疗程,治疗前后进行中医症候积分,采用动态血压仪监测24 h动态血压,采用免疫透射比浊法检测mALb、β2-MG,评价中医症状改善疗效。结果：尿联检（尿mALb＋尿β2-MG）检测的阳性率明显高于血BUN＋血Cr、单项尿MALB、血β2-MG、尿β2-MG,差异具有统计学意义（P〈0.05）。观察组和对照组治疗后眩晕、头痛、腰酸、膝软、夜尿频多、脉络瘀血、五心烦热、舌苔、脉象等中医症候积分均较治疗前明显下降（P〈0.05）,观察组治疗后除头痛外其他中医症候积分均明显低于对照组（P〈0.05）。观察组和对照组治疗后24h平均收缩压（24ASBP）、24h平均舒张压（24ADBP）均较治疗前明显下降（P〈0.05）,观察组治疗后24ASBP、24ADBP明显低于对照组（P〈0.05）。观察组和对照组治疗后mALb、β2-MG均较治疗前明显下降（P〈0.05）,观察组治疗后mALb、β2-MG明显低于对照组（P〈0.05）。观察组中医症候总有效率为89.41%,明显高于对照组64.71%,差异具有统计学意义（P〈0.05）。结论：尿mALb、β2-MG联合检测在高血压早期肾损害的疾病诊断、病情评判、效果评估具有重要意义,具有简易、无创、灵敏性高的优点,应该常规定期检测。
Objective ： To evaluate the clinical value of urinary microprotein in the diagnosis of early renal injury of essential hypertension and evaluation of the therapeutic effect of Yishen Pinggan Decoction. Methods ： Totally 200 patients with essential hypertension from January 2015 to October 2016 were enrolled in this study and 20 mL of urine was taken out to detect urinary albumin （mALb） and urinary 62 -mieroglobulin （62 -MG）. 3 mL blood sample was collected for detecting blood β2 -MG, blood urea nitrogen （BUN） and serum creatinine （Cr）. The positive rates of joint urine test and individual indicators were compared. The patients were divided into observation group and control group according to the random number table. The control group was treated with routine basal therapy. The observation group was treated with Yishen Pinggan Decoction on the basis of the control group and 30 days was a course of treatment. Both groups had been treated for 2 courses. The TCM syndrome score was measured before and after treatment. The dynamic blood pres- sure was monitored by dynamic blood pressure meter. The mALb and f32 - MG were detected by immunoturbidimetry. The curative effect of TCM was evaluted. Results： The positive rate of joint urinary test （urine mALb ＋ urine 152 -MG） was significantly higher than that of blood BUN ＋ blood Cr, single urine MALB, blood 152 - MG and urine β2 - MG. The difference was statistically significant （P 〈 0. 05）. The scores of dizziness, headache, backache, knee weakness, nocturia frequency, blood stasis in collaterals, dysphoria with feverish sensation in chest, palms and soles, tongue andpulse of the observation group and the control group after treatment were significantly lower than those before treatment （ P 〈0. 05）. The scores of TCM syndrome were significantly lower than those of the control group, except headache （ P 〈 0. 05 ）. The mean systolic blood pressure （24ASBP） and 24 h daily mean diastolic blood pressure （24ADBP） in the ob- servation group and the control group after treatment were significantly lower than those before treatment （P 〈 0.05）. The 24ASBP and 24ADBP in the observation group were significantly lower than those in the control group （ P 〈 0.05）. The levels of mALb and β2 - MG in the observation group and the control group after treatment were significantly lower than those before treatment （P 〈0. 05）. The levels of mALb and β2 - MG in the observation group after treatment were signif- icantly lower than those of the control group （P 〈0. 05）. The total effective rate was 89.41% in the observation group, which was significantly higher than that in the control group （64.71%） and the difference was statistically significant （P 〈 0. 05）. Conclusion ： The combination of urine mALb and [32 - MG has great significance in the disease diagnosis, con- dition evaluation and effect evaluation in early renal injury of essential hypertension, which has the advantages of simple, noninvasive and high sensitivity. It should be regnlarly tested.
作者
杨江民
张嘉毅
YANG Jianmin;ZHANG Jiayi(Clinical Lab, Qinghai Hospital of TCM, Xining 810000, Qinghai, China)
出处
《中华中医药学刊》
CAS
北大核心
2018年第2期492-495,共4页
Chinese Archives of Traditional Chinese Medicine
关键词
原发性高血压
肾损害
尿微量蛋白
益肾平肝汤
诊断
疗效
essential hypertension
renal damage
urinary microprotein
Yishen Pinggan Decoction
diagnosis
efficacy
作者简介
杨江民（1962-），男，陕西白水人，副主任检验师，研究方向：医学检验。
