摘要目的 本研究旨在观察痛风患者早期肾损害指标与肾脏超声表现之间的关系,以及降尿酸治疗后早期肾损害是否可逆.方法 选择2016年7月至2017年12月就诊于北京市海淀医院及北京大学人民医院风湿免疫科的痛风患者进行肾脏超声检查.根据肾脏超声检查结果分为以下3组:A组为正常表现,B组为点状结晶表现,C组为肾结石.每组各纳入患者30例.再从B组及C组中选择能坚持规律降尿酸治疗1年的患者.检测各种分组患者以及降尿酸治疗1年前后患者的尿视黄醇结合蛋白(RBP)、β2-微球蛋白(β2-MG)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)的水平.结果 A、B、C组痛风患者尿β2-MG浓度分别为(128.59±107.32)、(316.08±207.41)及(311.25±162.85)mg/L,3组间差异有统计学意义(P＜0.001).尿NAG浓度分别为(13.41±5.12)、(17.88±6.19)及(18.48±9.84)U/L,3组间差异有统计学意义(P＜0.01).尿RBP浓度3组间差异无统计学意义(P=0.188).降尿酸治疗1年后尿RBP、β2-MG及NAG的水平较治疗前降低,各组治疗前后均差异有统计学意义(P＜0.05).B组治疗后较C组尿β2-MG、NAG水平均有所降低(P＜0.05).结论 肾脏超声检查有利于痛风早期肾损害的诊断.降尿酸治疗后痛风患者早期肾损害指标均有降低,提示如果能够对痛风患者早期肾损害进行早期诊断,并及时治疗,早期肾损害可逆.

abstractsObjective To observe the relationship between early renal damage markers and renal ultrasonic manifestations in gout patients,and whether early renal damage is reversible after uric acid-reducing treatment.Methods The gout patients from the Department of Rheumatology of Beijing Haidian Hospital and Peking University People's Hospital between July 2016 and December 2017 were recruited in this study.According to the results of renal ultrasonography,the patients were divided into the following three groups.Group A was normal.Group B was punctate crystallization.Group C was renal calculi.Each group included 30 patients.The patients in group B and group C who could insist on regular uric acid-reducing treatment for one year were selected.The levels of urinary RBP,β2-MG and NAG were measured in different groups and one year before and after uric acid-reducing treatment.Results The urinary concentration of β2-MG in group A,group B and group C were (128.59± 107.32),(316.08±207.41) and (311.25 ± 162.85)mg/L,respectively.There were significant differences among the three groups (P＜ 0.001).The urinary concentration of NAG were (13.41±5.12)U/L,(17.88±6.19)U/L and (18.48±9.84)U/L,respectively.There were differences among the three groups (P＜0.01).There was no significant difference in urinary RBP concentration among the three groups (P=0.188).After one year of uric acid-reducing treatment,the levels of urinary RBP,β2-MG and NAG were lower than that before treatment.There were significant differences before and after treatment in each group (P＜0.05).Compared with group C,the levels of urinary β2-MG and NAG were decreased in group B after uric acid-reducing treatment (all P＜0.05).Conclusions Renal ultrasonography is helpful for the diagnosis of early renal damage in gout patients.Early renal damage markers in gout patients decreased after uric acid-reducing treatment,suggesting that early renal damage can be reversible if early diagnosis and timely treatment can be made in gout patients.