|
|
- 2016
肥胖儿童早期肾脏损害指标的相关因素分析
|
Abstract:
摘要：目的 分析肥胖儿童早期肾脏损害的敏感指标及影响肾损害的相关因素。方法 按照尿中微量白蛋白(MAU)的水平将肥胖儿童分为肥胖肾损组、肥胖非肾损组，并选择正常体重儿童作为对照组，比较不同组间尿β2微球蛋白(β2MG)、尿白蛋白(ALB)、尿IV胶原纤维蛋白(CIV)，尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)的水平。并用多元线性回归进一步分析肾脏损害的危险因素。结果 单因素方差分析发现，尿MAU、CIV在3组间比较均具有统计学差异(P<0.05)，进一步用LSD检验发现CIV两组间比较均具有统计学差异(P<0.05)，尿MAU在肥胖非肾损组与肥胖肾损组间比较具有统计学差异(P<0.05)，在对照组与肥胖非肾损组间比较无统计学差异(P>0.05)；多元线性回归分析显示，收缩压标准化分值(SDS-SBP)、BMI标准化分值(SDS-BMI)、CIV、TNF-α与尿MAU显著相关。结论 肥胖儿童主要以肾小球损害为主；CIV预测肾小球损害是更灵敏的指标；SDS-SBP、SDS-BMI、CIV、TNF-α为儿童肥胖肾脏损害的危险因素。
ABSTRACT: Objective To analyze the sensitive markers of early obesity-related renal injury and explore the related risk factors for renal injury. Methods Obese children were divided into kidney injury obese group and non-kidney injured obese group according to urinary micro-albumin (MAU) level, and the children with normal weight served as the control group. Urinary β2-microglobulin (β2MG), urinary albumin (ALB), urinary protein collagen IV (CIV), urinary N-acetyl-β-D-glucosaminidase (NAG) levels were compared between the groups. And risk factors for renal injury were analyzed by multivariate linear regression. Results We found that urinary MAU and CIV significantly differed among the three groups by ANOVA (P<0.05). Urine CIV significantly differed between any two groups (P<0.05). Urinary MAU differed significantly between non-kidney injured obese group and kidney-injured obese group (P<0.05), but not between non-kidney injured obese group and control group (P<0.05). SDS-SBP, SDS-BMI, CIV and TNF-α were closely related to renal injury in obese children by multivariate linear regression. Conclusion Obese children have mainly glomerular damage. CIV is a more sensitive indicator of glomerular damage. SDS-SBP, SDS-BMI, CIV and TNF-？？ are risk factors for obesity-related renal injury
| [1] | 中国肥胖问题工作组.中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准[J]. 中华流行病学杂志, 2004, 25(2):97-102. |
| [2] | 郭咏霞，吴梅青. 儿童单纯性肥胖合并肾功能损害的初步调查[J]. 现代医院, 2009, 9(1):23-24. |
| [3] | 刘晓琴，李明. 糖尿病肾病的早期诊断及预防[J]. 实用医技杂志, 2007, 14(30):4201-4202. |
| [4] | THOENES M, REIL JC, KHAN BV, et al. Abdominal obesity is associated with microalbuminuria and an elevated cardiovascular risk profile in patients with hypertension[J]. Vasc Health Risk Manag, 2009, 5(4):577-585. |
| [5] | FERRIS M, HOGAN SL, CHIN H, et al. Obesity, albuminuria, and urinalysis findings in US young adults from the Add Health Wave III study[J]. Clin J Amer Soci Neph, 2007, 2(6):1207-1214. |
| [6] | 金雅丽，张倩辉，郭艺芳. 尿微量白蛋白[J]. 中华高血压杂志, 17(3):283-286. |
| [7] | GOKNAR N, OKTEM F, OZGEN IT, et al. Determination of early urinary renal injury markers in obese children[J]. Pedi Neph, 2015, 30(1):139-144. |
| [8] | EKNOYAN G. Obesity and chronic kidney disease[J]. Nefrologia, 2011, 31(4):397-403. |
| [9] | AGARWAL S, PRABHU VM, ARUN S, et al. Correlation of microalbuminuria with cardiovascular morbidity in essential hypertension[J]. Int J Clin Cas Inves, 2014, 5(6):67-76. |
| [10] | HARA H, KOUGAMI K, SHIMOKAWA K, et al. The prevalence and risk factors of microalbuminuria in hypertensive patients under current medical treatment[J]. Int Med, 2014, 53(12):1275-1281. |
| [11] | DING W, MAK RH. Early markers of obesity-related renal injury in childhood[J]. Ped Nephr, 2015, 30(1):1-4. |
| [12] | MULAY SR, LINKERMANN A, ANDERS HJ. Necroinflammation in kidney disease[J]. J Am Soc Nephrol, 2015, 27(1):405-410. |
| [13] | GEORGIANOS PI, SARAFIDIS PA, LIAKOPOULOS V. Arterial stiffness: A novel risk factor for kidney injury progression[J]. Am J Hyper, 2015, 2015, 28(8):958-965. |
| [14] | 沈雯雯，刘志红，陈慧梅，等. 肥胖相关性肾病: 体重指数与蛋白尿的关系[J]. 肾脏病与透析肾移植杂志, 2009 (6):504-512. |
| [15] | CHANG A, VAN HORN L, JACOBS DR, et al. Lifestyle-related factors, obesity, and incident microalbuminuria: the CARDIA (Coronary Artery Risk Development in Young Adults) study[J]. Am J Kid Dise 2013, 62(2):267-275. |
