| Background Hypertension is one of the most common chronic disease that do harm to human health. In recent years, the prevalence of hypertension increases year by year. Kidney is an important organ that can adjust blood pressure, and it is also one of the target organs hypertension injures. Early hypertensive renal injury is a long-term, last and gradual progress. It usually appears 5-10 years after suffering from hypertension. Early hypertensive renal injury has no obvious symptoms and signs. When routine inspections present positive results, they always indicate that renal injury has already developed to a rather serious level,and at that time,renal injury is usually irreversible. Therefore, we need to look for more sensitive biochemical indicators that can prompt early hypertensive renal injury.Microalbumin(m ALb) is a kind of macromolecular protein. Under normal circumstances, glomerular filtration membrane has the effect of charge-barrier. Almost all m ALb cannot go through filtration membrane,and very small amounts of m ALb excrete out of our body with urine.Hypertension damages glomerular filtration membrane and destroy its effect of charge-barrier, and this cause the permeability of glomerular increases. Than our body excrete more m ALb, which is far beyond proximal convoluted tubule can reabsorption. Finally, urinary m ALb excretion increases. Therefore, m ALb is a reliable indicator of early hypertension renal injury.Cystatin C(Cys C) is a low molecular polypeptide chain. It generates in a constant speed, and its serum concentration has no relationship with age, sex, diet, inflammation, drugs, liver disease or other factors. And Cys C in the blood almost entirely filtrated by glomerular filtration, its discharge is only influenced by glomerular filtration rate(GFR). So, Cys C is an ideal indicator which can indicate glomerular filtration function.Alpha-1-microglobulin(α1-MG) is a small molecule protein that is composed of 167 amino acids. Beta-2-microglobulin(β2-MG) is a single-chain polypeptide consists of 100 amino acid residues. Under normal circumstances, α1-MG and β2-MG generate and exclude constantly. They are almost entirely reabsorbed by the proximal convoluted tubules(99.9%) and degraded. They never return to the blood circulation,and contains minimal in urine. Serum α1, β2 microglobulin may reflect glomerular filtration dysfunction or glomerular high load,while their elevated levels can reflect the severity of renal injury.Objective1. Compare the content of blood α-1-microglobulin, β-2-microglobulin,cystatin C between experimental group and control group, and evaluate their diagnosis value of early hypertensive renal injury.2. Compare the content of blood α-1- microglobulin, β-2-microglobulin,cystatin C among hypertension of different levels and different historys,and then analyze the relationship between the degree of early hypertensive renal injury and the content of these indicators.3. Compare the positive rate of blood α-1-microglobulin,β-2-microglobulin, cystatin C, urine microalbumin. Then compare their sensitivity in diagnosis of early hypertensive renal injury.METHOD The subjects were 120 cases of inpatients of cardiology with hypertension in our hospital from July 2015 to March 2016. Which contained 58 male patients and 62 female patients. Their age ranged from35 years old to 65 years old, of which the oldest was 65 years old and the youngest was 37 years old. Their average age was(54.30±8.26) years old. That contained 18 patients with stage I hypertension, 11 cases of male patients, 7 cases of female patients. 38 patients with stage Ⅱhypertension, 16 cases of male patients, 22 cases of female patients. 64 patients with stage Ⅲ hypertension, 31 cases of male patients, 33 cases of female patients. That contained 43 patients with hypertension histories less than 5 years, 18 cases of male patients, 25 cases of female patients.48 patients with hypertension histories between 5 years and 10 years, 23 cases of male patients, 25 cases of female patients. 29 patients with hypertension histories more than 10 years, 17 cases of male patients, 12 cases of female patients. All these patients didn’t take hypertensor for experimental, and present a high blood pressure when admitted to hospital. All selected patients contented the standard of 《 Chinese Hypertension Prevention Guide The 2010 Revision 》. Their creatinine(Cr), blood urea nitrogen(BUN), urinary protein were at normal levels,and excluded: Secondary hypertension, diabetes, cancer, tuberculosis,connective tissue disease, acute and chronic hepatitis, kidney disease, the influence of drugs and other diseases that will affect the result of this experiment. At the same time, we chose 40 cases of healthy citizens.Which contained 17 male patients and 23 female patients. Their age ranged from 35 years old to 65 years old, of which the oldest was 64 years old and the youngest was 35 years old. Their average age was(51.95 ± 6.36)years old. And excluded: Secondary hypertension,diabetes, cancer, tuberculosis, connective tissue disease, acute and chronic hepatitis, history kidney disease, the influence of drugs and other diseases that will affect the result of this experiment. We set 120 hypertensive patients as the experimental group and 40 healthy citizens as the control group. Experimental group was divided into 3 groups according to the level of their hypertension: group I(patients with gradeⅠhypertension), group Ⅱ(patients with grade Ⅱ hypertension),group Ⅲ(patients with grade Ⅲ hypertension). And was divided into another 3 groups according to the history of their hypertension: 5 years group(patients with hypertension histories less than 5 years), 10 years group(patients with hypertension histories between 5 years and 10 years),long history group(patients with hypertension histories more than 10years). We collected fasting venous blood 3m L from patients of both groups, measured their blood α1-MG, β2-MG, Cys C, creatinine content;and collected clean urine 5m L of all the patients, measured their m ALb content.Blood α1-MG, β2-MG, Cys C, creatinine and urine m ALb content were measured by Second Hospital of Jilin University Biochemistry Clinical Laboratory. Urine m ALb was measured by the H-800 Automated Urine Analyzer.Blood α1-MG, β2-MG, Cys C,creatinine were measured by Backman DXC800 full automatic biochemical analyzers. Compared the differences of all the indicators between experimental group and control group. Then compared the differences among sub groups of experimental group. Then calculated the positive rates of every indicator. β2-MG normal reference value is0.80~2.80 mg·L-1, α1-MG normal reference value is 10~30 mg·L-1, Cys C normal reference value is 0.56~1.15 mg·L-1, Cr normal reference value is 44~106 μmol·L-1. m ALb normal reference value of biochemistry clinical laboratory is less than 0.15g·L-1, not exact values,so we just talk about its positive rate. We use statistic software SPSS 19.0 to analyze the result, measurement data are expressed as(x±s) groups were compared using the t test. The significant level is α=0.05, P < 0.05 has its statistically significance.Results1. The blood α1-MG,β2-MG,Cys C content of experimental group are higher then that of control group(table 2.1). Differences are statistically significant(P<0.05).2. The blood Cys C,β2-MG content of group Ⅱ are higher than that of group Ⅰ, differences are statistically significant(P<0.05). The α1-MG content of group Ⅱ doesn’t have statistically significant differences with group Ⅰ( P>0.05)(table 2.2). The blood α1-MG、Cys C and β2-MG content of group Ⅲ doesn’t have statistically significant differences with group Ⅱ(P > 0.05)(table 2.3). The blood α 1-MG, β 2-MG, Cys C content of group Ⅲ are higher than that of group Ⅰ, differences are statistically significant(P < 0.05)(table 2.4). The blood α 1-MG, β2-MG, Cys C content of 10 years group are higher than that of 5 years group, differences are statistically significant( P<0.05).(table 2.6). The blood α1-MG, β2-MG, Cys C content of long history group are higher than that of 10 years group, differences are statistically significant(P<0.05)(table 2.7). The blood α1-MG, β2-MG, Cys C content of long history group are higher than that of 5 years group, differences are statistically significant(P<0.05)(table 2.8).3. The positive rate of blood α1-MG, β2-MG, Cys C and urine m ALb of experimental group and control group,and that of sub groups of experimental group are in table 2.10,2.11.Conclusion1. The blood α1-MG, β2-MG, Cys C and urine m ALb can be diagnostic indicators of early hypertensive renal injury. And they increase earlier than usual indicators.2. The level of hypertensive renal injury is related to the level and history of hypertension, and is more closely related to the history of hypertension.Patients with higher hypertension levels and longer hypertension histories has more serious early hypertensive renal injury than those with less hypertension levels and shorter hypertension histories.3. Urine mALb have the highest positive rate among these indicators in experimental group.Urine m ALb have the highest positive rate while early hypertensive renal injury is not that serious. When early hypertensive renal injury is rather serious, early hypertensive renal injury has a higher positive rate. |
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