肾病综合征患者血浆抗凝血酶Ⅲ检测及其临床意义  

The assay and clinical significance of plasma antithrombin Ⅲ in adult nephritic syndrome patients

作　　者：汤曦[1] 王旭方[2] 张丽华[2] 陈朝红[2] 张炯[2] 张羽[2] 曾彩虹[2] 刘志红[2] 

机构地区：[1]南京大学医学院临床学院 [2]南京军区南京总医院,全军肾脏病研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2010年第5期407-412,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:比较分析不同病理类型肾病综合征患者血浆抗凝血酶III(antithrombin Ⅲ,AT-Ⅲ)浓度的差异及相关影响因素。方法:比较微小病变(minimal change disease,MCD,n=26)、局灶节段性肾小球硬化(focalsegmental glomerulosclerosis,FSGS,n=26)及膜性肾病(membranous nephropathy,MN,n=20)三组成人肾病综合征患者肾活检术前血尿AT-Ⅲ浓度及临床特点。选取20例健康成人作为正常对照。血尿AT-III浓度采用免疫速率比浊法检测。采用Person、Sperman方法及多元线性回归分析FSGS、MCD患者中影响血浆AT-III浓度的因素。结果:肾活检术时MN组尿蛋白、血清白蛋白、肌酐、总胆固醇、IgG与MCD和FSGS组差异显著(P<0.05);后两组间以上指标的差异无统计学意义(P>0.05)。FSGS组尿C3、α2巨球蛋白、N-乙酰-β-D-葡萄糖苷酶、视黄醇结合蛋白高于MCD和MN组(P<0.05)。26例(100%)MCD、23例(88.46%)FSGS、3例(15%)MN患者血浆AT-Ⅲ降低(P<0.05)。FSGS与MCD患者血浆AT-III浓度分别为(15.64±3.86)mg/dl、(18.10±4.8)mg/dl(P<0.05),均低于MN患者(28.08±4.23)mg/dl(P<0.05)。FSGS、MCD组尿AT-III>5mg/dl者分别为8/20例(40%)、4/22例(18.18%)(P>0.05),而MN组患者尿液AT-III含量均<5mg/dl(P<0.05)。一元回归发现FSGS患者中血浆AT-III浓度与尿蛋白(r=-0.505,P<0.05)负相关、血清白蛋白(r=0.559,P<0.01)正相关;MCD患者中血浆AT-III浓度与尿蛋白(r=-0.429,P<0.05)负相关,与血清白蛋白(r=0.564,P<0.01)、IgG(r=0.529,P<0.01)正相关。多元回归分析提示FSGS、MCD患者中血浆AT-III与血清白蛋白相关(R2=0.312、0.320,P<0.05)。随访中2例A-TⅢ降低的FSGS患者发生静脉血栓。结论:肾病综合征患者血浆AT-III浓度与病理类型有关。FSGS、MCD血浆AT-Ⅲ浓度较MN明显下降,可能源于尿液丢失的差异。Objective： To compare plasma antithrombin Ⅲ （AT-Ⅲ） concentration and related factors in adult nephrotic syndrome patients with different histological patterns. Methodology： Seventy-two adult nephrotic syndrome patients with different histological patterns were enrolled in this study. They were minimal change disease （ MCD, n = 26）, focal segmental glomerulosclerosis （ FSGS, n = 26） and membranous nephropahty （ MN, n = 20）. 20 healthy adults served as normal control. The blood and urinary samples were collected before renal biopsy. The levels of plasma and urine AT-Ⅲ were detected by immune rate nephelometry. The clinical characteristics at biopsy, plasma and urinary AT-Ⅲ were compared. The factors related to plasma AT-Ⅲ were analyzed by person, spearman methods, followed by multi-linear regression. Results：The levels of serum albuminin, creatinine, total cholesterol, IgG and proteinuria at biopsy in MN group were significantly different from FSGS and MCD group （ P 〈 0. 05 ）. The difference of these variables were not significant between FSGS and MCD group （ P 〉 0. 05 ）. The levels of urinary C3, % macroglobulin, N-acetyl-β-D-glucosaminidase, and retinol binding protein in FSGS group were higher than those in MCD and MN group （ P 〈 0. 05 ）. The plasma level of AT-Ⅲ concentration in FSGS and MCD were （ 15.64 ± 3.86 ） mg/dl and （ 18.10 ± 4. 8 ） mg/dl （ P 〈 0. 05 ）, respectively, which were less than that in MN （28.08 ± 4. 23） mg/dl. The plasma level of AT-Ⅲ was decreased in 26 cases （100%） of MCD, 23 （88.4%） of FSGS and 3 （15%） of MN （P〈0.05）. The level of urinary AT-Ⅲ was increased in 8 cases of 20 FSGS, 4 of 22 MCD and none of MN （ P 〈 0. 05）. The plasma AT-Ⅲ in FSGS group was correlated with serum albumin positively （ r = 0. 559, P 〈 0. 01 ）, and proteinuria negatively （ r = - 0. 505, P 〈 0. 05 ）. Similarly, the plasma AT-III in MCD group was correlated with serum albumin （r = 0. 564 ,P 〈 0. 05

关 键 词：肾病综合征 抗凝血酶Ⅲ 微小病变 局灶节段性肾小球硬化 膜性肾病 

分 类 号：R692.3[医药卫生—泌尿科学]