关键词: 尿视黄醇结合蛋白, β₂-微球蛋白, β-N-乙酰葡萄糖苷酶, 职业性铅中毒, 肾损伤, 诊断

Abstract: Objective To explore the application value of combined detection of urinary retinol binding protein（URBP）,β2-microglobulin（β₂-MG） and β-N-acetylglucosidase（NAG） in the early diagnosis of occupational lead poisoning with renal injury.Methods Totally 63 cases of patients with occupational lead poisoning admitted to Enshi Tujia and Miao Autonomous Prefecture Central Hospital from January 2018 to June 2021 were selected as the poisoning group,60 health examination people with a history of occupational lead exposure during the same period but with normal blood lead level were selected as the normal group,and 50 cases of healthy people with health examination who had no occupational lead exposure history and had normal blood lead level were enrolled as the control group. The observation and comparison were performed on blood lead,urinary lead,erythrocyte zinc protoporphyrin（ZPP）,blood urea nitrogen（BUN）,creatinine（Cr）,uric acid（UA）,cystatin C（CysC）,urinary RBP,β₂-MG and NAG.The correlation of urinary RBP,β₂-MG,NAG with blood lead and urinary lead was analyzed.The receiver operating characteristic curve（ROC） was used to evaluate the diagnostic efficiency of urinary RBP,β₂-MG,NAG alone and in combination on early renal injury. Results The levels of blood lead,urinary lead and ZPP in the poisoning group were higher than those in the normal group and the control group（all P<0.05）,and the levels in the normal group were higher than those in the control group（all P<0.05）.There were statistically significant differences in the levels of renal function indicators such as BUN,Cr,UA and CysC among the three groups（all P>0.05）.The levels of urinary RBP,β₂-MG and NAG were higher in the poisoning group than those in the normal group and the control group（all P<0.05）. The levels of urinary RBP,β₂-MG and NAG in the normal group were higher than those in the control group（all P<0.05）. The urinary RBP,β₂-MG and NAG were positively correlated with blood lead and urinary lead（all P<0.05）.The area under the curve,sensitivity and specificity for the diagnosis of early lead poisoning with renal injury were 0.875,84.13% and 78.33% by URBP（P<0.05）,were 0.950,90.48% and 90.00% by β₂-MG（P<0.05）,were 0.565,77.78% and 35.00% by NAG（P>0.05）,and were 0.991,93.65% and 98.33% of combined diagnosis by combined diagnosis.The combined diagnosis had the best efficiency on diagnosis of early lead poisoning with renal injury（P<0.05）. Conclusion The combined detection of urinary RBP,β2-MG and NAG can be used as an important early detection indicator for people with occupational lead poisoning complicated with renal injury,and it is worthy of clinical promotion.

Key words: Urinary retinol binding protein, β2-microglobulin, β-N-acetylglucosidase, Occupational lead poisoning, Renal injury, Diagnosis