尿Tamm-Horsfall蛋白水平联合尿液补体H因子水平和IgA肾病Haas分级及预后相关  

Urinary Tamm-Horsfall protein level combined with urinary complement factor H level can predict IgA nephropathy Haas classification and renal outcome

作　　者：王雅琴[1] 刘茂静[1] 周晶晶[1] 王素霞[2] 陈育青[1] 

机构地区：[1]北京大学第一医院肾内科,北京大学肾脏疾病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室,北京100034 [2]北京大学第一医院电镜室,北京100034

出　　处：《中国血液净化》2018年第2期82-87,共6页Chinese Journal of Blood Purification

基　　金：国家自然科学基金资助项目(81570664)

摘　　要：目的探讨肾活检时尿Tamm-Horsfall蛋白水平联合尿补体H因子水平与Ig A肾病患者的组织学分型及预后的相关性。方法选择在在北京大学第一医院接受肾活检和规律治疗及随访的Ig A肾病患者351例。收集其基线临床病理资料,病理表现按照Haas分级进行打分。检测基线时尿TammHorsfall蛋白水平和尿补体H因子水平,分析该两种因子与临床,病理及预后的相关性。预后指标用肾脏终点事件表示,肾脏复合终点事件包括:(1)终末期肾脏病[估算肾小球滤过率(estimated glomerular filtration rate,e GFR)<15m L/min?1.73 m2];(2)e GFR比初始下降≥50%;(3)血肌酐水平加倍。结果尿Tamm-Horsfall蛋白水平越低,同时补体H因子水平越高,Ig A肾病患者的24h尿蛋白定量越多(χ~2=37.899,P<0.001),血白蛋白水平(χ~2=37.487,P<0.001)、e GFR水平(F=16.333,P<0.001)水平越低;同时,按照Haas分型的组织学损伤更严重(χ~2=52.304,P<0.001),复合终点事件发生率更高(χ~2=35.678,P<0.001)。Kaplan-Meier生存分析曲线显示,尿中补体H因子越高,同时Tamm-Horsfall蛋白越低,患者的预后越差(Log Rankχ~2=31.938,P<0.001)。结论尿Tamm-Horsfall蛋白和尿补体H因子水平可联合预测是Ig A肾病患者的预后。尿液中补体H因子越高,尿Tamm-Horsfall蛋白水平越低,Ig A肾病患者的组织学Haas分型越严重,预后越差。Objectives To investigate whether urinary Tamm-Horsfall protein（u THP） level combined with urinary complement factor H（u CFH） level can correlate with Ig A nephropathy histology Haas classification and renal outcome. Methods A total of 351 Ig A nephropathy patients followed up from Sep.2003 to Sep. 2014 were enrolled in this study. Histological changes were evaluated by using the Haas classification of Ig A nephropathy. Enzyme linked immunosorbent assay（ELISA） was used to measure u THP and u CFH levels at the renal biopsy day. Composite endpoint of renal outcome was defined as（1）end-stage renal disease（ESRD）,（2）≥ 50% decline of estimated glomerular filtration rate（e GFR）, and（3）doubling of plasma creatinine level. Results In this cohort, patients with lower u THP level and higher u CFH level had more proteinuria（χ~2=37.899, P〈0.001）, lower blood albumin（χ~2=37.487, P〈0.001）, lower e GFR（F=16.333, P〈0.001）, severer histological lesion（χ~2=52.304, P〈0.001） and worse renal outcome（χ~2=35.678, P〈0.001）. Kaplan-Meier curve analysis indicated that lower u THP level with higher u CFH level predicted the worse renal outcome during follow-up（Log Rank test, χ~2=31.938, P〈0.001）. Conclusions u THP level combined with u CFH level can predict renal outcome in Ig A nephropathy patients. Patients with lower u THP and higher u CFH will have severer morphological lesions（Haas classification） and worse renal outcome.

关 键 词：TAMM-HORSFALL蛋白 补体H因子 IGA肾病 Haas分型 

分 类 号：R692.5[医药卫生—泌尿科学]