类风湿关节炎患者的微量白蛋白尿
Microalbuminuria in patients with rheumatoid arthritis.
作者信息
Pedersen L M, Nordin H, Svensson B, Bliddal H
机构信息
Department of Rheumatology, Copenhagen Municipal Hospital, Denmark.
出版信息
Ann Rheum Dis. 1995 Mar;54(3):189-92. doi: 10.1136/ard.54.3.189.
OBJECTIVES
To assess (a) the prevalence of microalbuminuria in patients with rheumatoid arthritis, (b) the association between urinary albumin excretion and disease activity as estimated by the erythrocyte sedimentation rate and C reactive protein (CRP), and (c) the association between urinary albumin excretion and treatment with antirheumatic drugs.
METHODS
Sixty five patients with rheumatoid arthritis attending two rheumatology clinics were compared with 51 control subjects matched by age and sex. The controls consisted of 20 healthy subjects, 16 patients with osteoarthritis and 15 with non-articular rheumatism. Patients with hypertension, diabetes mellitus, or evidence of previous renal disease were not included. Urinary albumin was assayed by immunoturbidimetry in random urine samples on two occasions within seven months. The results were expressed as the ratio of urinary albumin to urinary creatinine ratio. Disease activity was assessed by the erythrocyte sedimentation rate and CRP. A drug history for the year before entry to the study was obtained for each patient.
RESULTS
Urinary albumin to creatinine ratio in patients with rheumatoid arthritis was significantly greater than in controls (p < 0.01). Microalbuminuria (urinary albumin to creatinine ratio 3-30 mg/mmol in either or both urine samples) was present in 27.7% of patients with rheumatoid arthritis and 7.8% of the control subjects. A significant relation was noted between urinary albumin to creatinine ratio and CRP, and the duration of disease. The number of patients treated with either gold or penicillamine was significantly greater in patients with microalbuminuria than in patients with normoalbuminuria.
CONCLUSIONS
Microalbuminuria is frequently present in patients with rheumatoid arthritis. Treatment with gold and penicillamine seems to increase the risk of developing microalbuminuria. Urinary albumin measured by immunochemical methods is a simple and sensitive test to detect early subclinical renal dysfunction and drug induced renal damage in rheumatoid arthritis. Urinary albumin excretion was found to be significantly correlated with CRP and may be a sensitive indicator of disease activity in patients with rheumatoid arthritis.
目的
评估（a）类风湿关节炎患者微量白蛋白尿的患病率；（b）尿白蛋白排泄与通过红细胞沉降率和C反应蛋白（CRP）评估的疾病活动之间的关联；（c）尿白蛋白排泄与抗风湿药物治疗之间的关联。
方法
将65名在两家风湿病诊所就诊的类风湿关节炎患者与51名年龄和性别匹配的对照者进行比较。对照组包括20名健康受试者、16名骨关节炎患者和15名非关节性风湿病患者。排除患有高血压、糖尿病或既往有肾脏疾病证据的患者。在七个月内两次随机采集尿液样本，采用免疫比浊法检测尿白蛋白。结果以尿白蛋白与尿肌酐比值表示。通过红细胞沉降率和CRP评估疾病活动。获取每位患者入组研究前一年的用药史。
结果
类风湿关节炎患者的尿白蛋白与肌酐比值显著高于对照组（p < 0.01）。类风湿关节炎患者中27.7%存在微量白蛋白尿（一个或两个尿液样本中尿白蛋白与肌酐比值为3 - 30 mg/mmol），而对照组中这一比例为7.8%。尿白蛋白与肌酐比值和CRP以及病程之间存在显著关联。微量白蛋白尿患者中接受金制剂或青霉胺治疗的患者数量显著多于正常白蛋白尿患者。
结论
微量白蛋白尿在类风湿关节炎患者中很常见。金制剂和青霉胺治疗似乎会增加发生微量白蛋白尿的风险。通过免疫化学方法检测尿白蛋白是检测类风湿关节炎早期亚临床肾功能不全和药物性肾损伤的简单且敏感的试验。发现尿白蛋白排泄与CRP显著相关，可能是类风湿关节炎患者疾病活动的敏感指标。
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