原发性肾病综合征患者急性肾损伤标志物的检测及其意义  

The Significance of Detection of Acute Kidney Injury Markers in Patients with Nephrotic Syndrome

作　　者：雷文娟[1] 张铿[1] 潘庆军[1] 刘伟敬[1] 刘华锋[1] 

机构地区：[1]广东医学院附属医院肾病研究所,湛江524001

出　　处：《中国中西医结合肾病杂志》2016年第6期499-501,共3页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家自然科学基金资助项目(No.81470959;81570656);广东省自然科学基金资助项目(No.2014A030313540);2013广东省扬帆计划高层次人才资助项目

摘　　要：目的:通过检测尿中性粒细胞明胶酶相关性脂质运载蛋白(NGAL)、肾损伤因子(KIM-1)、白细胞介素-18(IL-18)及血胱抑素C(Cys C)水平,探讨其在判断原发性肾病综合征(PNS)病情中的价值。方法:采用ELISA法检测18例正常人和82例经肾脏病理确诊为PNS患者的尿NGAL、KIM-1、IL-18水平,并采用全自动生化分析仪检测其血清Cys C水平,分析其与PNS病理类型、肾小管-间质损伤程度及临床各指标的相关性。结果:(1)患者尿NGAL、KIM-1、IL-18和血清Cys C水平均显著高于正常人(P<0.05),且在微小病变型(MCD)、膜性肾病(MN)、局灶-节段性肾小球硬化症(FSGS)三种病理类型肾病综合征患者尿中有依次增高趋势;(2)伴有肾小管-间质损伤的尿NGAL、KIM-1、IL-18和血Cys C水平较未伴肾小管-间质损伤的明显升高(P<0.05),且其水平随着损伤程度的加剧而逐渐升高。(3)尿NGAL与血肌酐(Scr)水平呈密切正相关,尿KIM-1与肾小管-间质损伤程度呈密切正相关,血Cys C则与24 h尿蛋白定量呈密切正相关,尿IL-18与血清白蛋白(Alb)水平呈密切负相关。结论:尿NGAL、KIM-1、IL-18及血Cys C水平均可从一定程度反映PNS患者肾脏损伤及其严重程度。Objective： To explore the roles of acute kidney injury biomarkers,including NGAL,IL- 18,KIM- 1 and Cys C,in determining disease with primary nephrotic syndrome. Methods： The urinary levels of NGAL,KIM- 1,IL- 18 were detected by ELISA method and serum Cys C level was measured using the automatic biochemical analyzer in 18 cases of normal subjects and 82 patients with pathologically confirmed primary nephrotic syndrome. The correlations between these AKI biomarkers and the pathological types of PNS,tubulointerstitial lesions and clinical indicators were analyzed. Results：（ 1） The levels of urinary KIM- 1、NGAL、IL- 18 and serum Cys C in PNS group were significantly higher than that of control group（ P〈0. 05）. Moreover,these AKI biomarkers have an increasing tendency in MCD,MN and FSGS group successively.（ 2） The levels of urinary KIM- 1、NGAL、IL- 18 and serum Cys C in PNS accompanied with tubule- interstitial lesions group were significantly higher than the group has no tubule- interstitial lesion（ P〈0. 05）. Besides,with the severity of renal tubule- interstitial damage in renal pathology of PNS patients,the biomarker levels were gradually increased.（ 3） Urinary NGAL and Scr was positively correlated,KIM- 1 and tubuleinterstitial damage was positively correlated,Cys C and urinary protein in 24 hours was positively correlated,IL- 18 and Alb was negatively correlated.Conclusion： All of the urine NGAL,KIM- 1,IL- 18 and serum Cys C are biomarkers for reflecting,to some extent,the renal injury and the severity of damage in PNS patients.

关 键 词：原发性肾病综合征 急性肾损伤 NGAL KIM-1 IL-18 CYS C 

分 类 号：R692[医药卫生—泌尿科学]