【摘要】 目的 探讨高血压肾病患者血清尿调节蛋白（UMOD）和胱抑素C(Cys C）水平特点，分析UMOD,Cys C与临床病理特征和预后的关系。方法 选择2016年2月1日～2019年12月31日北京市昌平区中医医院收治的149例高血压肾病患者（肾病组）和92例体检志愿者（对照组），检测血清UMOD,Cys C，尿素氮（BUN）和血肌酐（SCr）水平，计算肾小球滤过率（eGFR），分析UMOD,Cys C与BUN,SCr,eGFR之间的相关性。肾病组给予B超引导下行肾穿刺活检获取肾组织病理学特征，比较不同病理特征间血清UMOD,Cys C水平差异。随访肾病组患者，Kaplan-Meier绘制不同UMOD,Cys C水平下高血压肾病患者生存曲线，Cox比例风险模型分析影响高血压肾病患者发生终末期肾病（ESRD）的因素。结果 肾病组血清UMOD(126.49±32.15ng/ml vs 158.26±45.92ng/ml),eGFR(60.35±16.31ml/min/1.73m~2 vs 121.38±12.06ml/min/1.73m~2）低于对照组（t=5.291,28.449，均P<0.05),Cys C(2.43±0.65ng/ml vs 0.73±0.29ng/ml),BUN(35.26±6.32mmol/L vs 13.02±2.43mmol/L）和SCr(165.23±25.16μmol/L vs 25.11±5.07μmol/L）水平均高于对照组（t=22.758,31.344,52.292，均P<0.05），差异有统计学意义。UMOD水平与BUN,Scr呈负相关（r=-0.769,-0.795，均P<0.05），与eGFR呈正相关（r=0.842,P<0.05),Cys C水平与BUN,SCr呈正相关（r=0.767,0.757，均P<0.05），与eGFR呈负相关（r=-0.812,P<0.05）。新月体形成、中重度肾小管萎缩/间质纤维化患者血清UMOD水平低于无新月体形成、轻度肾小管萎缩/间质纤维化患者（t=12.056,18.081，均P<0.05），肾小球球性硬化、肾小球节段硬化、肾小球缺血皱缩患者血清Cys C水平高于无肾小球球性硬化、无肾小球节段硬化、无肾小球缺血皱缩患者（t=26.665,19.508,17.985，均P<0.05），差异有统计学意义。低水平UMOD，高水平Cys C患者肾脏存活率低于高水平UMOD，低水平Cys C患者（Log Rankχ~2=7.960,4.683，均P<0.05）。肾小管萎缩和间质纤维化、低UMOD，高Cys C是高血压肾病患者发生ESRD的危险因素（均P<0.05）。结论 高血压肾病患者血清UMOD水平降低，Cys C水平升高，UMOD,Cys C均与肾组织病理特征以及ESRD的发生有关。更多还原

【Abstract】 Objective To investigate the characteristics of serum uromodulin (UMOD) and cystatin C (Cys C) levels in patients with hypertensive nephropathy,and analyze the relationship between UMOD and Cys C,and clinicopathological characteristics and prognosis.Methods 149 patients with hypertensive nephropathy who were admitted to the Beijing Changping District Hospital of Traditional Chinese Medicine from February 1 to 2016 and December 31,2019 (nephropathy group) and 92volunteers (control group) were selected.Serum levels of UMOD,Cys C,urea nitrogen (BUN) and serum creatinine (SCR) were detected,and the glomerular filtration rate (eGFR) was calculated.The correlation between UMOD,Cys C and BUN,SCR and EGFR were analyzed.Kidney biopsy guided by B-ultrasound was performed in the nephropathy group to obtain the histopathological characteristics of the kidney,and the differences in serum UMOD and Cys C levels among different pathological characteristics were compared.Patients in the nephropathy group were followed up.Kaplan-Meier drew survival curves of patients with different UMOD and Cys C levels,and Cox proportional risk model was used to analyze the factors affecting the occurrence of end-stage renal disease (ESRD) in patients with nephropathy.Results The levels of serum UMOD(126.49±32.15ng/ml vs 158.26±45.92ng/ml) and eGFR(60.35±16.31ml/min/1.73m~2 vs 121.38±12.06ml/min/1.73m~2)in nephropathy group were lower than those in control group (t=5.291,28.449,all P<0.05),and the levels of Cys C(2.43±0.65ng/ml vs 0.73±0.29ng/ml),BUN(35.26±6.32mmol/L vs 13.02±2.43mmol/L) and Scr(165.23±25.16μmol/L vs 25.11±5.07μmol/L) were higher than those in control group (t=22.758,31.344,52.292,all P<0.05),the differences were statistically significant,repectively.UMOD level was negatively correlated with BUN and Scr (r=-0.769,-0.795,P<0.05),and positively correlated with EGFR (r=0.842,P<0.05).Cys C level was positively correlated with BUN and Scr (r=0.767,0.757,all P<0.05),and negatively correlated with EGFR (r=-0.812,P<0.05).The serum UMOD level in patients with crescent formation and moderate to severe tubuloatrophy/interstitial fibrosis was lower than that in patients without crescent formation,and in patients with mild tubuloatrophy/interstitial fibrosis (t=12.056,18.081,all P<0.05),the level of serum Cys C in patients with glomerular sclerosis,segmental sclerosis and glomerular ischemia wrinkle was higher than that in patients without glomerular sclerosis,segmental sclerosis and glomerular ischemia wrinkle (t=26.668,19.508,17.985,all P<0.05),the differences were statistically significant,respectively.The renal survival rate of patients with low level of UMOD and high level of Cys C was lower than that of patients with high level of UMOD and low level of Cys C (Log Rankχ~2=7.960,4.683,all P<0.05).Tubule atrophy,interstitial fibrosis,low UMOD and high Cys C were risk factors for ESRD in patients with hypertensive nephropathy (all P<0.05).Conclusion The level of serum UMOD decreased and Cys C increased in patients with hypertensive nephropathy.Both UMOD and Cys C are related to the pathological characteristics of renal tissue and the occurrence of ESRD.更多还原