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目的探讨尿微量蛋白作为危重患者早期肾损害监测指标的可行性。方法前瞻性动态监测ICU危重患者一周内尿微量白蛋白(MA)、α_1-微球蛋白(α_1-MG)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、视黄醇结合蛋白(RBP),并分别与同期尿蛋白定量、肾小球滤过率(以肌酐清除率CCr表示)、血Cr(SCr)比较。结果在危重患者中MA、α_1-MG、RBP、NAG尿发生率分别为：80%、83%、63%、87%,四种微量蛋白联测阳性率为93%,而血Cr阳性率仅27%,尿蛋白阳性率66%,肌酐清除率阳性率77%。肾功能不全组较未发生肾功能不全组尿MA、α_1-MG、RBP升高具有统计学意义(P＜0．05),而NAG差异无统计学意义。结论动态监测尿MA、α_1-MG、RBP可作为危重患者早期肾损害监测的临床指标。
Objective To investigate the feasibility of urine microalbumin as an indicator of early renal damage in critically ill patients. Methods The prospective and dynamic monitoring of urinary albumin (MA), α_1-MG, NAG, retinol binding protein (RBP), respectively, with the same period of urinary protein, glomerular filtration rate (creatinine clearance rate CCr said), blood Cr (SCr) comparison. Results The prevalences of MA, α 1-MG, RBP and NAG in critically ill patients were 80%, 83%, 63% and 87%, respectively. The positive rates of the four trace proteins were 93% 27%, urine protein positive rate of 66%, creatinine clearance rate of 77%. The levels of MA, α 1-MG and RBP in patients with renal dysfunction were significantly higher than those without renal dysfunction (P <0.05), while there was no significant difference in NAG. Conclusions Dynamic monitoring of urinary MA, α 1-MG and RBP can be used as clinical indicators for early renal damage monitoring in critically ill patients.