探究β₂微球蛋白、胱抑素C、单核细胞趋化蛋白-1在高尿酸血症患者肾功能损害早期诊断中的意义

郭金香 江立千 谭雪莉 赵乐华 刘冰玉

【摘要】 目的 探究β2微球蛋白（β2-MG）、胱抑素C（Cys C）、单核细胞趋化蛋白-1（MCP-1）在高尿酸血症（HUA）患者肾功能损害早期诊断中的意义。

方法 选取2018年6月～2020年3月收治的HUA患者86例作为研究组，另选取同期健康体检者54人作为对照组，抽取两组研究对象空腹静脉血，检测并比较两组血清中β2-MG、Cys C、MCP-1水平，比较研究组中不同性别及是否合并肾功能损害患者血清中上述指标水平，分析血尿酸与血清β2-MG、Cys C、MCP-1水平的相关性，以及β2-MG、Cys C、MCP-1水平对HUA患者肾功能损害的早期诊断价值。

结果 研究组患者血清β2-MG、Cys C、MCP-1水平显著高于健康对照者（P<0.05）;研究组中男性患者血清β2-MG、Cys C、MCP-1水平高于女性患者（P<0.05），合并肾损害患者血清β2-MG、Cys C、MCP-1水平高于未合并肾损伤患者（P<0.05）;Pearson相关性分析显示，HUA患者血尿酸水平与血清β2-MG、Cys C、MCP-1均呈正相关（r=0.482、0.463、0.672，P<0.001）;β2-MG、Cys C、MCP-1诊断HUA患者肾功能损害的最佳截断值分别为2.05 mg/L、0.95 mg/L、173.87 pg/mL，对应的AUC值分别为0.911（95%CI 0.851～0.952）、0.855（95%CI 0.786～0.909）、0.921（95%CI 0.863～0.960），三项指标联合诊断肾功能损害的灵敏度为87.21%，特异度为98.84%。

结论 高尿酸血癥患者血清β2-MG、Cys C、MCP-1水平上升，可成为高尿酸血症患者肾功能损害早期诊断的有效指标。

【关键词】 高尿酸血症;肾功能损害;早期诊断;β2微球蛋白;胱抑素C;单核细胞趋化蛋白-1

中图分类号：R692   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.03.012

Exploration on significance of β2-MG， Cys C and MCP-1 in early diagnosis of renal function impairment in patients with hyperuricemia

GUO Jinxiang， JIANG Liqian， TAN Xueli， ZHAO Lehua， LIU Bingyu

（Department of Clinical Laboratory， Shengde Hospital， Xinyang 464000， Henan， China）

【Abstract】 Objective To investigate the significance of β2 microglobulin （β2-MG）， cystatin C （Cys C） and monocyte chemoattractant protein-1 （MCP-1） in the early diagnosis of renal function impairment of patients with hyperuricemia （HUA）.

Methods 86 HUA patients admitted to hospital from June 2018 to March 2020 were selected as study group， and 54 healthy people who underwent physical examination during the same period were selected as control group. Fasting venous blood were collected from two groups， the levels of β2-MG， Cys C and MCP-1 of the two groups were detected and compared. In addition， the levels of the above-mentioned indicators in serum of patients with different sex and renal impairment in the study group， and correlation between serum uric acid and levels of serum β2-MG， Cys C and MCP-1 as well as diagnostic value of β2-MG， Cys C and MCP-1 levels on renal function impairment in HUA patients were analyzed.

Results The levels of serum β2-MG， Cys C and MCP-1 in the study group were significantly higher than those in the healthy control group （P < 0.05）. The levels of serum β2-MG， Cys C and MCP-1 of male patients in the study group were higher than those in female patients （P < 0.05）. The levels of serum β2-MG， Cys C and MCP-1 of patients with renal injury were higher than those of patients without renal injury （P < 0.05）. Pearson correlation analysis showed that the serum uric acid level of HUA patients was significantly positively correlated with serum β2-MG， Cys C and MCP-1 （r = 0.482， 0.463， 0.672， P < 0.001）. The best cutoff values of β2-MG， Cys C， and MCP-1 in the diagnosis of renal function impairment in HUA patients were 2.05 mg/L， 0.95 mg/L and 173.87 pg/mL， respectively， and the corresponding AUC values were 0.911 （95%CI 0.851-0.952）， 0.855 （95%CI 0.786-0.909） and 0.921 （95%CI 0.863-0.960）. In addition， the sensitivity and specificity of the combined  diagnosis of the above three indexes for renal function impairment were 87.21% and 98.84%， respectively.

Conclusion The increases of β2-MG， Cys C， and MCP-1 among patients with hyperuricemia may be used as effective indicators for early diagnosis of renal function impairment in patients with hyperuricemia.

【Key words】 HUA; renal function impairment; early diagnosis; β2-MG; Cys C; MCP-1

高尿酸血症（hyperuricemia，HUA）是一种嘌呤代谢障碍性疾病，导致机体尿酸排泄减少或生成过多，目前我国HUA发病率为8.4%～13.3%，且呈现年轻化趋势[1]。既往研究表明，肾脏对尿酸排泄具有重要作用，若尿酸长期累积在肾脏，可对肾脏造成实质性损伤，导致HUA肾病[2]。尿酸难溶于水，易形成尿酸结晶，而无论是游离的尿酸还是尿酸结晶均对肾脏组织有促炎作用，且尿酸结晶也会造成梗阻[3]。单核细胞趋化蛋白-1（monocyte chemotactic protein 1，MCP-1）是一种常见的炎症指标，其可反映机体炎症水平，MCP-1能激活单核细胞迁移及聚集，产生炎症反应，使血管内皮细胞受损，促使肾小球硬化，进而对肾脏造成不可逆损伤[4]。近年来，有研究指出，β2-微球蛋白（β2-microglobulin，β2-MG）、胱抑素C（Cystatin C，Cys C）可用于早期发现肾损伤[5]。……