Detection of indicators of early renal injury in patients with COPD and its clinical significance / 中国综合临床

ABSTRACT

Objective To explore the indicators change of early renal injury in patients with chronic obstructive pulmonary disease (COPD) and its clinical significance.Methods Ninety cases of COPD including 45 cases with stable period of COPD,45 cases with acute exacerbation of COPD who received treatment in Baoshan Branch of Shanghai General Hospital from January 2014 to December 2014 were enrolled in this study.Meanwhile 45 cases of healthy subjects were collected as the control group.According to the extent of hypoxia,the COPD patients were divided into mild subgroups (60mmHgserum cystatin C (CysC),β2-microglobulin (β2-MG),serum creatinine (Scr) and C-reactive protein (CRP) were detected among all groups,and estimated glomerular filtration rate (eGFR) was calculated,left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were measured by Cardiac Doppler ultrasound.Results Serum Cys-C,β2-MG,Scr values and eGFR values were significantly lower in the control group than in the stable period group and acute exacerbation group,(Cys-C (104.5±20.9) μg/L vs.(133.9±15.4) μg/L vs.(147.8±21.2) μg/L);β2-MG (1.5±0.3) mg/L vs.(2.4±0.4) mg/L vs.(2.8±0.4) mg/l);Scr (74.4±10.7) nmol/L vs.(81.1±17.5) nmol/L vs.(90.4±20.3) nmol/L);eGFR (97.2±14.8) ml/min·1.73m2 vs.(89.9±18.6) ml/min·1.73m2 vs.(78.3±17.8) ml/min·1.73m2,F=12.18,4.97,7.39,8.16,P<0.05).Compared with the control group,the levels of serum Cys-C,β2-MG and Scr in all the COPD subgroups were significantly increased,an obvious decrease was seen in eGFR value,the differences were all statistically significant (P<0.05).There was significant difference on indicators of early renal injury between stable period group and acute exacerbation period group (P<0.05).Compared with the control group,the levels of serum Cys-C and β2-MG in different COPD subgroups were significantly increased along with the increase in hypoxia extent (Cys-C (104.5±20.9) μg/L vs.(122.8±22.5) μg/L vs.(136.7±31.6) μg/L vs.(150.8±39.7) μg/L;β2-MG(1.5±0.3) mg/L vs.(1.9±0.3) mg/L vs.(2.4±0.5) mg/L vs.(2.9±0.4) mg/L;Scr(74.4±10.7) nmol/L vs.(78.6±12.4) nmol/L vs.(82.1±13.4) nmol/L vs.(94.8±17.3) nmol/L;eGFR(97.2±14.8) ml/min·1.73m2 vs.(93.8±15.3) ml/min·1.73m2 vs.(88.6±12.2) ml/min·1.73m2 vs.(74.4±10.7) ml/min·1.73m2,P<0.05);compared with the control group and mild subgroup,the level of Scr in moderate and severe subgroup increased obviously,while eGFR decreased significantly (P<0.05).CRP was positively correlated with Cys-C andβ2-MG (r=0.407,0.379),LVEF had significantly negative correlation with Cys-C,β2-MG and Scr (r=-0.488,-0.391,-0.306),and developed positive correlation with eGFR (r=0.311),LVEDD and eGFR were significantly negatively correlated (r=-0.482) (P<0.05).Conclusion Early renal damage are commonly seen in COPD patients due to chronic hypoxia,serum Cys C,β2-MG are closely correlated with heart-kidney functions and can be used as a monitoring indicator of early cardiac and renal function impairment in COPD patients.