Ⅱ型和Ⅲ型儿童紫癜性肾炎肾小管早期损伤的评价  

Evaluation of early renal tubular injury in grade Ⅱ and grade Ⅲ Henoch-Sch?nlein purpura nephritis in children

作　　者：杨晓青[1] 黄岩杰[1] 张龙真[1] 李静[1] 梅晓峰[1] 李金刚[1] 毕亮亮[1] 翟文生[1] 宋纯东[1] 

机构地区：[1]河南中医药大学第一附属医院儿科,郑州450000

出　　处：《郑州大学学报（医学版）》2018年第1期97-101,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省科技创新杰出青年科技计划基金资助项目(144100510014);河南省省属高校基本科研业务专项自主创新和应用基础研究项目(2014KYYWF-ZZCX2-03)

摘　　要：目的:结合紫癜性肾炎(HSPN)肾脏病理分型,评价尿小分子蛋白α1微球蛋白(α1m)、视黄醇结合蛋白(RBP)和N-乙酰-β-D-氨基葡萄糖苷酶(NAG)是否能及时反映HSPN肾小管的损伤。方法:选取33例正常儿童、99例单纯过敏性紫癜(HSP)患儿、101例HSPN患儿(Ⅱa型21例、Ⅱb型13例、Ⅲa型41例、Ⅲb型26例)。HSPN患儿肾组织行HE、PAS、PASM、Masson染色,显微镜下观察评估肾小球、小管间质病变;用免疫比浊方法检测3组儿童尿标本α1m、RBP,用酶比色法检测尿NAG酶。结果:病理形态结果显示,HSPNⅡ型未见明显肾小管间质病变,HSPNⅢ型病理上可见散在肾小管上皮细胞肿胀、脱落,肾小管间质炎细胞浸润和灶性肾小管萎缩,多为轻度病变。与正常对照和HSP患儿比较,HSPNⅡ型患儿尿α1m[(1.591±1.365)g/mol]、RBP[(4.583±3.576)g/mol]和NAG酶[(20.321±11.262)U/g]均升高(P<0.01)。与HSPNⅡ型相比,HSPNⅢ型尿α1m[(2.032±1.811)g/mol]、RBP[(8.102±7.193)g/mol]和NAG酶[(31.236±24.985)U/g]的水平进一步升高(P<0.01),且尿α1m和尿RBP的水平呈正相关(r=0.513),尿NAG酶与肾小球新月体百分比呈正相关(r=0.331)。与Ⅲa型相比,HSPNⅢb型患儿尿α1m、RBP均升高(P<0.05),尿NAG酶的水平两组间差异无统计学意义。结论:尿α1m、RBP和NAG酶联合检测有助于早期评价HSPN肾小管损伤的状态和程度,其敏感性高于肾组织病理检测。新月体形成可加重肾小管上皮细胞的损伤。Aim： To evaluate whether the urinary levels of alpha-1-microglobulin（ α1m）,retinol-binding protein（ RBP） and N-acetyl-β-D-glucosaminidase（ NAG） could reflect timely renal tubular injury in Henoch-Sch？nlein purpura nephritis（ HSPN）,combining with renal pathological grade of HSPN. Methods： A total of 33 normal children,99 Henoch-Sch？nlein purpura（ HSP） and 101 children with HSPN were collected. Renal specimens from HSPN were stained by HE,PAS,PASM and Masson staining,and glomerulus,tubular and interstitial lesions were observed and evaluated by light microscopy. The levels of urinary α1m and RBP were detected using immunonephelometry method,and the level of urinary NAG was tested using enzymatic colorimetry method. Results： The pathological features of HSPN grade Ⅱ cases showed that few renal tubular and interstitial lesions were observed,but compared with normal control and HSP group,the levels of urinary α1m [（ 1. 591 ± 1. 365） g/mol],RBP [（ 4. 583 ± 3. 576） g/mol] and NAG[（ 20. 321 ± 11. 262） U/g]were obviously increased（ P〈0. 01）. Compared with grade HSPN Ⅱ cases,the levels of urinary α1m [（ 2. 032 ± 1. 811）g/mol],RBP[（ 8. 102 ± 7. 193） g/mol] and NAG [（ 31. 236 ± 24. 985） U/g] were further increased in grade HSPN Ⅲcases（ P〈0. 01）. Mild renal tubular epithelial swelling and shedding,inflammatory cell infiltration,tubular basement membrane thickening and atrophy were observed in grade HSPN Ⅲ cases. The concentration of urinary α1m was positively correlated with that of urinary RBP（ r = 0. 513）,and the level of urinary NAG were positively correlated with the percentage of glomerular crescent in grade HSPN Ⅲ cases（ r = 0. 331）. Compared with HSPN grade Ⅲa cases,the levels of urinaryα1m and RBP were obviously increased in HSPN grade Ⅲb cases（ P〈0. 05）,but there was no obvious difference in NAG. Conclusion： The combined detection of urinary α1m,RBP and NAG may contribute to early evaluation and dynamic monit

关 键 词：紫癜性肾炎 肾小管损伤 Α1微球蛋白 视黄醇结合蛋白 NAG酶 

分 类 号：R725.7[医药卫生—儿科]