尿纤溶酶水平对糖尿病肾病水肿的影响

Urinary plasmin level is the risk factor of edema in patients with early stage nephrotic syndrome of diabetic kidney disease

关键词:  糖尿病肾病  水肿  纤溶酶  原发性钠潴留

Key words:  diabetic kidney disease  edema  plasmin  primary sodium retention

摘要:

目的 探讨糖尿病肾病（diabetic kidney disease, DKD）进入肾病综合征（nephrotic syndrome, NS）阶段（DKD-NS）后尿纤溶酶（uPL）对水肿的影响。方法 收集109例NS住院患者的血、尿标本，其中43例为DKD-NS患者，66例为其他肾小球疾病的NS阶段（非DKD-NS）患者，按血白蛋白（sALB）浓度≥25g/L和<25g/L将NS分为早期和中后期。比较NS各期中DKD-NS组和非DKD-NS组的一般资料，血液、尿液各项检测指标和血、尿纤溶酶原（PLG）-纤溶酶（PL）水平，采用Logistic回归分析DKD-NS水肿的影响因素。结果 在NS各期中，DKD-NS组的水肿评分、尿纤溶酶原-纤溶酶肌酐比值（uPLG-PL/C）均显著高于非DKD-NS组（P<0.05）；在早期NS中，DKD-NS组的水肿发生率也显著高于非DKD-NS组（P<0.01）。Logistic回归分析显示，在早期NS中，uPLG-PL/C分级是DKD-NS水肿的危险因素（OR=2.961，95%CI 1.544~5.678，P=0.001）；而在中后期NS中，uPLG-PL/C分级并非DKD-NS水肿的危险因素（P>0.05）。结论 uPL水平是早期DKD-NS阶段水肿的独立危险因素。对于早期DKD-NS，uPL水平较高的患者更易发生水肿。

Abstract:

Objective To investigate the association of urinary plasmin level with the edema in patients with diabetic kidney disease (DKD) in nephrotic syndrome (NS) stage (DKD-NS). Methods Urine and serum samples from 109 patients with NS were collected, including 43 of DKD-NS and 66 cases of NS with other glomerular diseases (non DKD-NS). NS patients with serum albumin concentration (sALB) ≥25 g/L were classified as early stage and those with sALB <25 g/L as mid-late stage. The general information, laboratory tests of urine and serum, including plasminogen (PLG)-plasmin (PL) were compared between DKD-NS and non DKD-NS patients in different stages of NS; and their association with the clinical phenotype was analyzed. The risk factors of edema in DKD-NS patients were analyzed by Logistic regression. Results The severity of edema and urinary PLG-PL/C levels in early and mid-late NS patients of DKD-NS group were both significantly higher than those of non DKD-NS group (P<0.05). The incidence of edema in early NS patients of DKD-NS group was also significantly higher than that of non DKD-NS group (P<0.01). Multivariate Logistic regression analysis showed that uPLG-PL/C grade (OR=2.961, 95%CI： 1.544-5.678, P=0.001) was the risk factor of edema in early NS patients of DKD-NS group, but not in mid-late NS patients (P>0.05). Conclusion Urinary level of plasmin is an independent risk factor of edema formation in early stage of DKD-NS patients.