慢性肾脏病患者血清和尿透明质酸、Ⅲ型前胶原、Ⅳ型胶原及层粘连蛋白的变化及其临床意义  

Changes and clinical significance of hyalaronic acid,procollagen type Ⅲ,collagen type Ⅳ and laminin in the serum and urine in patients with chronic renal diseases

作　　者：沈文清[1] 傅君舟[2] 钱捷[1] 梁敏灵[1] 张金山[3] 梁波[1] 

机构地区：[1]广州医学院第三附属医院肾内科,广州510150 [2]广州市第一人民医院肾内科 [3]广州医学院第三附属医院核医学科,广州510150

出　　处：《临床医学》2010年第6期4-7,共4页Clinical Medicine

摘　　要：目的探讨慢性肾脏病患者血清和尿透明质酸(HA)、Ⅲ型前胶原(PC-Ⅲ)、Ⅳ型胶原(C-Ⅳ)、层粘连蛋白(LN)的变化与肾功能的关系。方法将90例慢性肾脏病患者分为肾功能正常组、氮质血症组、尿毒症组,对照组为健康体检者,测定血、尿HA、C-Ⅳ、LN及PC-Ⅲ含量。结果血清C-Ⅳ、LN及PCⅢ水平:氮质血症组、尿毒症组与对照组组间差异,氮质血症组与尿毒症组组间差异均有统计学意义(P<0.01)。血清HA水平:各组间差异均有统计学意义(P<0.01)。氮质血症组、尿毒症组血清HA、PCⅢ、C-Ⅳ、LN水平分别与血肌酐(Cr)水平呈正相关。尿液C-Ⅳ、LN及PC-Ⅲ水平:各组间差异均有统计学意义(P<0.01)。尿液HA水平:氮质血症组、尿毒症组与对照组组间差异,及氮质血症组与尿毒症组组间差异均有统计学意义(P<0.01)。氮质血症组、尿毒症组尿液C-Ⅳ、LN水平分别与血Cr水平呈正相关(P<0.05),氮质血症组、尿毒症组尿HA分别与血Cr水平呈负相关(P<0.01)。结论血清、尿液HA、C-Ⅳ、LN及PC-Ⅲ的变化可作为临床判断肾纤维化发生与发展的间接参考指标,联合测定四种指标在血清和尿中的变化情况,比单一指标检测可能可以进一步提高判断肾纤维化发生和进展的敏感性和特异性。Objective To explore the relationship between hyalaronic acid（HA）,procollagen type Ⅲ（PC-Ⅲ）,collagen type Ⅳ（C-Ⅳ）,laminin in serum and urine and the renal function. MethodsHA,C-Ⅳ,LN and PC-Ⅲ in blood and urine were all measured in 30 patients with chronic renal disease with normal renal function patients（group A）,30 patients with chronic renal failure with azotemia patients（group B）,30 uremia patients（group C） and 26 controls（group D）. ResultsFor serum level of PC-Ⅲ,C-Ⅳ and LN,the differences between group B and group D,group C and group D,group B and group C were significant（P〈0.01）.For serum level of HA,there were significant differences in all groups.For urine level of PC-Ⅲ,C-Ⅳ and LN,there were significant differences in all groups.For urine level of HA,the differences between group B and group D,group C and group D,group B and group C were significant（P〈0.01）.There were significant positive correlation with level of serum creatinine and level of serum HA,C-Ⅳ,LN,PC-Ⅲ of group B and group C respectively.There were significant positive correlation with level of serum creatinine and level of urine C-Ⅳ,LN of group B and group C respectively.There were significant negative correlation with level of serum creatinine and level of urine HA of group B and group C.ConclusionThe variations of serum/urine level of HA,C-Ⅳ,LN,PC-Ⅲ,being an indirect index for the occurrence and development of chronic renal fibrosis,could be used in dignosis and treatment of chronic renal disease easily and quickly.The combined measurement of four items in serum and urine could appear to be a more sensitive marker of the progression of renal fibrosis than any one item.

关 键 词：慢性肾脏病 透明质酸 Ⅲ型前胶原 IV型胶原 层粘连蛋白 

分 类 号：R692[医药卫生—泌尿科学]