霉酚酸酯对IgA肾病患者血清和尿液sTfR水平的影响  

Effect of Mycophenolate Mofetil on Expression of Serum and Urine sTfR in Immunoglobulin a Nephropathy

作　　者：关米洁 何永成[1] 李彤[1] 万启军[1] 陈洪滔[1] 

机构地区：[1]广东省深圳市第二人民医院肾内科,深圳518037

出　　处：《中国中西医结合肾病杂志》2016年第5期414-418,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：深圳市科创委技术开发项目(No.CXZZ20140421155346007)

摘　　要：目的：探讨Ig A肾病（Ig AN）患者血清、尿液可溶性转铁蛋白受体（soluble transferrin receptor,s TfR）水平以及霉酚酸酯（mycophenolate mofetil,MMF）对其水平的影响。探讨MMF治疗Ig AN可能的机制。方法：用ELISA法检测健康对照组19例（C组）、与MMF组匹配初诊未治疗Ig AN 39例（Ig AN组）、MMF治疗组48例（MMF组）血清、尿液s TfR的水平,比较各组表达差异性。结果：尿液s TfR的检测结果显示Ig AN组、MMF组均较C组表达显著增加（514.99±196.23）,[（356.36±222.82）vs（110.43±64.78）ng/mg.Cr,P=0.000,0.000],MMF组较Ig AN组表达下降（P=0.03）。Ig AN组尿液s TfR表达与e GFR呈负相关（r=-0.559,P=0.002）,与病理级别、血肌酐、尿蛋白呈正相关（r=0.423、0.550、0.575,P=0.007、0.000、0.000）。将Ig AN组按LEE分级〉3级（n=18）、≤3级（n=21）分成两组,前者尿液s TfR显著高于后者[（600.87±196.81）vs（441.38±167.07）ng/mg.Cr,P=0.010]。将MMF治疗组按疗程3~6个月（n=23）、〉6个月（n=25）分成两组,前者尿液s TfR显著高于后者[（435.56±223.49）vs（283.50±199.76）ng/mg.Cr,P=0.014]。结论：Ig AN患者尿液s TfR表达水平显著增加,且与尿蛋白排泄、肾功能进展及肾脏病理损伤程度等密切相关。MMF可显著降低Ig AN患者尿液s TfR水平,且疗程在6月以上者更为显著。尿液s TfR可作为预测Ig AN病变进展及评估MMF治疗Ig AN疗效的生物标志物。Objective： We observed the level of sTiR in serum and urine, and investigated the effect of MMF on it in immunoglobulin A nephropathy（IgAN） patients, to explore the possible mechanisms of MMF for IgAN. Methods ：The sample was divided into three groups： health control group（ Group C）that was composed of 19 healthy volunteers, Group IgAN that was formed by 39 patients without any treatment, and MMF treatment group included 48 patients treated with MMF. The level of sTiR in serum and urine was detected in all sample of three groups by ELISA, the result of which was compared among three groups. Results： Comparing with Group C, both the Group IgAN and Group MMF exhibited higher expression of sTiR in urine [ （514.99± 196.23）, （356.36± 222.82 ） vs （ 110.43 ±64.78 ） ng/mg. Cr, P = 0.000,0. 000 ]. Comparing with Group IgAN, lower level of sTiR in urine were found in Group MFF （ P = 0. 03 ）. In Group IgAN, the level of sTiR in urine was negatively correlated with eGFR （ r = - 0. 559, P = 0. 002 ） , while positively correlated with the pathological grading, Scr, urine protien （ r = 0. 423,0. 550,0. 575, P = 0. 007,0.000,0. 000 ）. We divided Group IgAN into two group aecordding to whether the LEE clasifieation was higher than grade three, we found the group （ n = 18 ） with the LEE elasification higher than grade 3 exhibited obvious higher level of sTiR in urine than that of the other group （ n = 21 ） with the LEE clasification less than grade 3 [ （600.87 ±196.81 ） vs （441.38 ±167.07）ng/mg. Cr, P =0. 010]. We divided Group MFF into two groups, we found that the level of sTiR of urine in the group （ n = 23 ） that had been treated with MFF for 3 to 6 months was significantly higher than that in the other group （ n = 25 ） that had been treated with MFF for more than 6 months [ （435.56 ± 223.49） vs （283.50 ±199.76）ng/mg. Cr, P = 0.014）. Conclusion ：The level of sTiR in urine was significantly elevated in IgAN patients, and its expression is closely

关 键 词：IGA肾病 sTfR 霉酚酸酯 生物标记物 

分 类 号：R692.31[医药卫生—泌尿科学]