评估白蛋白尿和尿蛋白在早期诊断某些类型肥胖表型的肾功能紊乱中的作用

A. G. Gadaev, R. K. Dadabayeva
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In the observation groups, anthropometric indicators, blood pressure, biochemical tests and blood lipid spectrum, levels of leptin, insulin, cystatin C and uromodulin in the blood serum, gradations of microalbuminuria in urine were determined, the glomerular filtration rate was calculated for cystatin C and creatinine and the obtained indicators were compared.Results. In both obesity phenotypes, the amount of microalbuminuria and cystatin C significantly increased in group 1 compared to these indicators in group 2 and the control group, and the amount of uromodulin in the blood serum, on the contrary, decreased compared to the indicators in group 2 and control group (r ˂ 0.001) . An increase in the gradation of microalbuminuria and cystatin C and a decrease in the amount of uromodulin in the blood serum in both groups was expressed by a decrease in the estimated glomerular filtration rate, which was clearly expressed in group 1 (χ2 = 4.5, r = 0.034). 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引用次数: 0

摘要

目的:研究肥胖表型中反映肾脏损伤的生物标志物与肾脏功能状态的关系,以及与临床、代谢、激素参数和免疫炎症过程的关系:研究涉及 224 名肥胖的乌兹别克妇女,根据代谢综合征的推荐标准将她们分为两组:第一组包括 133 名被诊断为代谢性复杂肥胖的妇女,平均年龄为(42.0±0.5)岁;第二组包括 91 名被诊断为代谢性健康肥胖的妇女,平均年龄为(41.7±0.7)岁。对照组包括 45 名健康志愿者(女性,平均年龄(43.2±0.8)岁,体重指数 ˂ 30 kg/m2,腰围小于 80 厘米)。在观察组中,测定了人体测量指标、血压、生化检查和血脂谱、血清中瘦素、胰岛素、胱抑素 C 和尿肌蛋白的水平、尿液中微量白蛋白尿的等级,计算了胱抑素 C 和肌酐的肾小球滤过率,并对所得指标进行了比较。在两种肥胖表型中,与第 2 组和对照组的指标相比,第 1 组的微量白蛋白尿和胱抑素 C 的量明显增加,而与第 2 组和对照组的指标相比,血清中尿肌酐的量反而减少(r ˂ 0.001)。两组微量白蛋白尿和胱抑素 C 分级的增加以及血清中尿肌球蛋白量的减少都表现为估计肾小球滤过率的下降,这在第 1 组中表现明显(χ2 = 4.5,r = 0.034)。此外,体重指数的增加还表现为心脏代谢紊乱的增加、微量白蛋白尿分级的增加、血清中尿蛋白水平的降低和细胞因子血症(p ˂0.001)。在这两种肥胖表型中,肥胖程度的增加表现为心脏代谢风险水平的增加,以及亚临床肾损伤的增加。在肥胖症肾功能障碍的早期诊断中,测定血清中尿蛋白和胱抑素 C 的含量并评估微量白蛋白尿的分级是适当的。
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Assessment of the role of albuminuria and uromodulin in the early diagnosis of renal function disorders in some types of obesity phenotypes
The aim: to study of the relationship of biological markers reflecting damage of the kidneys with its functional state, as well as with clinical, metabolic, hormonal parameters and immunoinflammatory processes in obesity phenotypes.Patients and Methods: The study involved 224 obese Uzbek women who were divided into 2 groups according to the recommended criteria for metabolic syndrome: group 1 consisted of 133 women diagnosed with metabolic complicated obesity, average age 42.0±0.5; Group 2 consisted of 91 women diagnosed with metabolic healthy obesity, average age 41.7±0.7. The control group consisted of 45 healthy volunteers (women, mean age 43.2±0.8, body mass index ˂ 30 kg/m2, waist circumference less than 80 cm). In the observation groups, anthropometric indicators, blood pressure, biochemical tests and blood lipid spectrum, levels of leptin, insulin, cystatin C and uromodulin in the blood serum, gradations of microalbuminuria in urine were determined, the glomerular filtration rate was calculated for cystatin C and creatinine and the obtained indicators were compared.Results. In both obesity phenotypes, the amount of microalbuminuria and cystatin C significantly increased in group 1 compared to these indicators in group 2 and the control group, and the amount of uromodulin in the blood serum, on the contrary, decreased compared to the indicators in group 2 and control group (r ˂ 0.001) . An increase in the gradation of microalbuminuria and cystatin C and a decrease in the amount of uromodulin in the blood serum in both groups was expressed by a decrease in the estimated glomerular filtration rate, which was clearly expressed in group 1 (χ2 = 4.5, r = 0.034). Also, an increase in body mass index was characterized by an increase in cardiometabolic disorders, an increase in the gradation of microalbuminuria, a decrease in the level of uromodulin in the blood serum and cytokinemia (p ˂ 0.001).Conclusion. In both obesity phenotypes, an increase in the degree of obesity was manifested by an increase in the level of cardiometabolic risk, as well as an increase in subclinical kidney damage. It is considered appropriate to determine the amount of uromodulin and cystatin C in blood serum and assess the gradation of microalbuminuria in the early diagnosis of renal dysfunction in obesity.
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