Wilkinson S P, Hirst D, Day D W, Williams R
J Clin Pathol. 1978 Feb;31(2):101-7. doi: 10.1136/jcp.31.2.101.
Measurements of urinary lysozyme were used to evaluate renal tubular integrity in 34 patients with cirrhosis or fulminant hepatic failure who had developed renal impairment. In 18 of the patients the lysozyme values were normal but in the remaining 16 were increased, supporting previous concepts that renal failure complicating hepatocellular disease may occur both without and with tubular necrosis. The lysozyme values were inversely related to the creatinine clearance, suggesting that the development of tubular necrosis may be determined by the level of renal perfusion. The validity of simpler laboratory tests often used to assess renal tubular integrity--namely, the urine sodium concentration, the urine:plasma osmolality ratio, and casts in the urine sediment--was evaluated by comparison with the lysozyme measurements. The urine sodium concentration was of most value and the findings in the sediment were of no value at all.
对34例已出现肾功能损害的肝硬化或暴发性肝衰竭患者，测定尿溶菌酶以评估肾小管完整性。18例患者的溶菌酶值正常，但其余16例升高，这支持了先前的观点，即肝细胞疾病并发的肾衰竭可能在无肾小管坏死和有肾小管坏死的情况下发生。溶菌酶值与肌酐清除率呈负相关，提示肾小管坏死的发生可能由肾灌注水平决定。通过与溶菌酶测量结果比较，评估了常用于评估肾小管完整性的更简单实验室检查的有效性，即尿钠浓度、尿与血浆渗透压比值以及尿沉渣中的管型。尿钠浓度最有价值，而尿沉渣中的发现则毫无价值。
