低分子尿蛋白在评估多发性骨髓瘤早期肾损害中的作用  

Significance of Low Molecular Weight Urinary Protein for Assessment of Early Renal Damage in Patients with Multiple Myeloma

作　　者：刘诗静[1] 翟勇平[1] 于亚平[1] 刘海宁[1] 李锋[1] 宋萍[1] 周小刚[1] 安志明[1] 邵靓婧[1] 杨小燕[1] 

机构地区：[1]南方医科大学南京临床学院(南京军区南京总医院)血液科,江苏南京210002

出　　处：《中国实验血液学杂志》2013年第2期410-414,共5页Journal of Experimental Hematology

基　　金：南京军区医学科技创新经费资助项目(编号10MA096)

摘　　要：本研究旨在评估低分子尿蛋白诊断多发性骨髓瘤(MM)早期肾脏损害的临床诊断意义。回顾性分析2004年1月至2012年5月初诊的278例MM患者临床资料,按肾脏损害分为3组:肾小球损害组(血肌酐Scr≥2mg/dl)143例;肾小管损害组(Scr<2 mg/dl,尿视黄醇结合蛋白(retinol-binding protein,RBP)≥0.5 mg/L,尿N-乙酰-β-D-氨基葡萄糖胺酶(N-acetyl-β-D-aminoglucoamidase,NAG)≥17.8 U/g.cr)114例;无肾小球和肾小管损害的正常组21例。对3组间性别、年龄、分型、分期、血红蛋白(Hb)、血清白蛋白(Alb)、尿RBP及尿NAG等临床和实验室指标的差异进行比较,进一步分析所有患者尿RBP、尿NAG与血尿素氮(BUN)、血Scr、血胱抑素-C(Cys-C)、内生肌酐清除率(Ccr)、24 h尿蛋白、24 h尿轻链的相关性;并分析61例行肾脏活检患者的肾小管间质病变评分与低分子尿蛋白的相关性,使用ROC曲线比较尿RBP和尿NAG对MM早期肾脏损害的诊断效果。结果表明,肾小球损害组尿RBP显著高于肾小管损害组,而尿NAG显著低于肾小管损害组,两组尿RBP和尿NAG显著高于正常组;尿RBP与血Scr、血BUN、血Cys-C、24 h尿蛋白呈正相关,与Ccr呈负相关,而尿NAG与24 h尿蛋白、Ccr呈正相关,与血Cys-C呈负相关;肾小管间质病变与尿RBP显著相关,与尿NAG相关性较弱。结论:尿RBP与肾小管损害有明显的相关性,与尿NAG相比能更好地反映肾损伤的程度,并且特异性更高。This study was purposed to evaluate the clinical significance of low molecular weight urinary proteins for diagnosis of early renal damage in patients with multiple myeloma （MM）. Medical records of 278 patients with MM in Nanjing School of Clinical Medicine from January 2004 to May 2012 were analyzed retrospectively. These patients were divided into 3 groups： glomerular damage group （n = 143 ）, tubular damage group （n = 114 ） and normal group （n = 21 ）. The clinical and laboratorial data were compared among them. The correlations of urinary retinol-binding protein （RBP） or urinary N-acetyl-β-D-aminoglucoamidase （NAG） with blood urea nitrogen （BUN）, Scr, blood cystatin-C （Cys-C）, clearance of creatinine （Ccr）, 24 h protein uria and 24 h urine light chains were further analyzed, and the correlation of renal tubulointerstitial lesion scores with low molecular weight urinary proteins in 61 patients were also ana- lyzed. The area under curve （ROC curve） was used to evaluate and compare the discrimination of urinary RBP and uri- nary NAG. The results showed that glomemlar damage group had higher urinary RBP than tubular damage group. How- ever, glomerular damage group had lower urinary NAG than tubular damage group. The two groups had higher urinary RBP and urinary NAG than that in normal group. Urinary RBP related positively to the level of Scr, BUN, Cys-C, 24 h proteinuris and related negatively to the level of Ccr. Urinary NAG related positively to the level of 24 h proteinuris, Ccr and related negatively to the level of Cys-C. Renal tubulointerstitial lesions were significantly correlated with urinary RBP, but weakly correlated with urinary NAG. It is concluded that urinary RBP significantly correlates with renal tubular damage. Compared with urinary NAG, urinary RBP can better assess the extent of renal damage, and has higher speci- ficity.

关 键 词：多发性骨髓瘤 早期肾脏损害 低分子尿蛋白 

分 类 号：R733.3[医药卫生—肿瘤]