The relationship between the serum bilirubin and the renal function of the obstructive jaundice patients
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摘要: 目的 探讨梗阻性黄疸患者的血胆红素对肾功能的影响，研究血总胆红素(total bilirubin，TBIL)和血直接胆红素(direct bilirubin，DBIL)与尿管型之间的相关性。方法 随机选取2022年1月—2022年6月因梗阻性黄疸住院的90例患者为研究组，根据显微镜镜检尿管型的结果将研究对象分为2组，其中尿管型阳性组42例，尿管型阴性组48例。另选取同期50例健康体检者为对照组。所有对象采用贝克曼AU-5800检测TBIL、DBIL、尿素(BUN)和肌酐(Cr)。患者留取随机中段尿，2 h内离心后，取上清液检测尿β2微球蛋白(β2-MG)和尿视黄醇结合蛋白(RBP)，留取0.2 mL沉渣显微镜镜检管型。结果 ① 研究组管型阳性率均显著高于对照组(46.67% vs 10.00%，χ2=19.38，P < 0.01)。②管型阳性组的TBIL、DBIL、BUN和Cr高于管型阴性组(P=0.015、0.044、< 0.001、0.006)；管型阳性组和管型阴性组的尿β2-MG和尿RBP均显著高于对照组(P管型阳性组=0.018、< 0.001，P管型阴性组=0.013、0.004)。③TBIL、DBIL与尿管型阳性率均呈正相关(χTBIL2=12.15，P < 0.01；χDBIL2=12.28，P < 0.01)，单变量分析显示TBIL[OR(95%CI) 7.875(2.861~21.676)，P=0.03]和DBIL[OR(95%CI) 7.543(2.740~20.765)，P=0.012]均可预测尿管型阳性。结论 梗阻性黄疸患者的高胆红素血症导致患者的肾小管功能损害，若伴尿管型阳性，其肾小球功能亦可能受损，且血胆红素水平与管型阳性率呈正相关。Abstract: Objective To explore the relationship between the serum bilirubin and the renal function of the obstructive jaundice patients and study the correlation between serum bilirubin levels and urine cast.Methods A total of 90 obstructive jaundice inpatients were collected as study objects from Wuhan Union hospital during January and June, 2022. Another 50 healthy physical examination visitors were selected as controls. Random middle urine samples were collected and sent to the lab within 2 hours. After the IQC of each instrument was passed, the urine samples were detected by dry chemical analysis, automated sediment analyzer, quantitative analysis of urine protein and microscope review.Results ① The positive rate of cast of the study group was obviously higher than that of the control group(46.67% vs 10.00%, χ2=19.38, P < 0.01). ②The TBIL, DBIL, BUN and Cr of patients with cast(+) were obviously higher than those of patients with cast(-)(P=0.015, 0.044, < 0.001, 0.006), the urine β2-MG and urine RBP of patients with cast(+) and patients with cast(-) were obviously higher than those of the controls(Ppatients with cast(+) =0.018, < 0.001, Ppatients with cast(-) =0.013, 0.004). ③ The TBIL and DBIL were both positively related with the urine cast positive rate(χTBIL2=12.15, P < 0.01; χDBIL2=12.28, P < 0.01). On univariate analysis, TBIL(OR[95%CI] 7.875[2.861-21.676], P=0.03) and DBIL(OR[95%CI] 7.543[2.740-20.765], P=0.012) were found to be significant predictors of urine cast.Conclusion Hyperbilirubinemia of the obstructive jaundice patients may lead to the renal tubule function disorders and glomerular function may also be disordered if urine cast was(+) and TBIL and DBIL were both positively related with the urine cast positive rate.
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Key words:
- serum bilirubin /
- the renal function /
- cast
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表 1 管型阳性和阴性患者的实验室检查结果差异分析
指标 管型阳性组(n=42) 管型阴性组(n=48) 对照组(n=50) P1 P2 P3 TBIL/(μmol/L) 219.08±140.49 133.31±95.8 12.36±2.68 0.015 ＜0.001 ＜0.001 DBIL/(μmol/L) 127.29±88.98 80.73±60.74 4.46±1.34 0.044 0.001 ＜0.001 BUN/(mmol/L) 6.87±5.16 4.48±1.62 5.01±0.96 0.001 0.001 0.011 Cr/(μmol/L) 80.9±59.86 64.70±16.97 66.52±11.51 0.006 0.001 0.006 尿β2-MG/(mg/L) 0.34(0.10~5.76) 0.30(0.05~5.76) 0.15±0.1 0.350 0.018 0.013 尿RBP/(mg/L) 0.22(0.10~7.74) 0.16(0.10~7.74) 0.17±0.1 0.082 ＜0.001 0.004 P1：管型阳性组与管型阴性组差异分析；P2：管型阳性组与对照组差异分析；P3：管型阴性组与对照组差异分析。 
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表 2 TBIL、DBI与尿管型阳性率的相关性分析
指标 例数 尿管型阳性/例 尿管型阳性率/% TBIL/(μmol/L) < 85.5 26 6 23.08 85.6~170.0 27 15 55.56 171.0~255.5 17 8 47.06 255.6~341.0 9 4 44.44 DBIL/(μmol/L) < 34 17 4 23.53 35~67 20 7 35.00 68~101 17 11 64.71 102~135 9 5 55.56 >136 27 15 55.56
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