成人微小病变患者尿中CD80水平及临床意义  

Urinary CD80 level in adult patients with minimal change disease

作　　者：王晓荣[1] 李绍梅[1] 杨林[1] 谭会斌[1] 李素敏[1] 傅淑霞[1] 

机构地区：[1]河北医科大学第二医院肾内科,石家庄050000

出　　处：《肾脏病与透析肾移植杂志》2014年第3期216-220,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的：探讨成人微小病变（MCD）患者尿液CD80在MCD发生与发展中的作用及其对MCD与局灶节段性肾小球硬化（FSGS）鉴别诊断的意义. 方法：MCD患者35例（肾病组初治9例和复发10例,完全缓解组16例）,其中9例初治患者经随访后完全缓解,行自身配对研究;同期原发FSGS肾病综合征患者18例.记录所有患者相关资料.ELISA法测尿CD80浓度（ng/ml）及血清白细胞介素13（IL-13） （pg/ml）水平,其中尿CD80值用尿肌酐值（g/ml）校正. 结果：（1）尿CD80/肌酐水平：MCD肾病组明显高于MCD完全缓解组或FSGS肾病组[247.0ng/g（196.0～ 378.0ng/g）vs 42.0 ng/g（24.0～76.3 ng/g） 、73.0 ng/g（35.3～ 172.0 ng/g）,P＜0.05],MCD完全缓解组与FSGS肾病组无统计学差异;MCD初治组与复发组无统计学差异.（2）血IL-13水平在MCD肾病组、MCD完全缓解组及FSGS肾病组中无统计学差异.（3）自身配对研究示：MCD完全缓解后较治疗前尿CD80/肌酐水平显著下降[41.0 ng/g（17.0～61.5 ng/g） vs 323.0 ng/g（225.5～587.5 ng/g）,Z=2.666,P=0.008],而血IL-13水平无统计学差异（Z=0.847,P=0.397）.（4） MCD肾病组尿CD80/肌酐与24h尿蛋白定量及血IL-13水平均无相关性（分别r=-0.219,P=0.369;r=0.303,P=0.205）.（5）尿CD80鉴别诊断MCD和FSGS的ROC曲线下面积（AUC）为0.883（截点为194.5 ng/ml,其敏感度为78.9％,特异性为88.9％）. 结论：CD80可能参与了MCD发生及发展,且可作为成人肾病综合征患者MCD与FSGS鉴别诊断的新指标.Objective：We investigated the level of urinary CD80 in patients with minimal change disease （MCD）and with focal segmental glomerulosclerosis （FSGS） to explore whether it could be helpful in differentiating MCD from FSGS.Methodology：Thirty five patients with biopsy proven MCD were studied including 9 cases of primary MCD,10 cases of relapse and 16 cases of remission.The patients in the first two groups were manifested by nephrotic syndrome.18 patients with biopsy proven FSGS were aiso included in the study.The clinical and chemical data were recorded.Urinary CD80（ng/ml） was measured using a commercially available ELISA kit and the results were adjusted by using urinary creatinine excretion.IL-13 levels of serum were evaluated by ELISA kit.Results：A significant increase of urinary CD80,normalized to urinary creatinine,was found in patients with MCD with nephrotic syndrome compared to those in remission （P〈0.05） and those with FSGS （P〈0.05）.No significant differences of urinary CD80 were seen between MCD in remission and those with FSGS （P=0.079）,neither between primary MCD and those in relapse （P=0.121）.In paired study on the cases of primary MCD patients,the level of urinary CD80 in all the patients having a remission after treatment was statistically lower than that before treatment （Z =2.666,P =0.008）.No significant differences of serum IL-13 were seen in these two groups （Z =0.847,P =0.397）.There was no difference of serum concentrations of IL-13 among those three groups （P〉0.05）.In patients of MCD with nephrotic syndrome,there was no correlation between urinary CD80 and proteinuria （r=-0.219,P =0.369）,neither between urinary CD80 and serum IL-13 （r=0.303,P=0.205）.ROC-AUC of urinary CD80 for differential diagnosis between MCD and FSGS was 0.883 （cut off 194.5 ng/ml,sensibility 78.9%,specificity 88.9%）.Conclusion：Urinary CD80 might be related to the development of MCD in the patients with nephrotic syndrome.Urinary CD80 may be a useful marker to d

关 键 词：尿CD80 肾病综合征 微小病变 局灶节段性肾小球硬化 白细胞介素13 

分 类 号：R692[医药卫生—泌尿科学]