nephrin表达与糖尿病肾病预后相关性研究  

Relationship between nephrin and prognosis of diabetic nephropathy

作　　者：王荣珍[1] 姚灿 刘沨[2] Wang Rongzhen;Yao Can;Liu Feng(Department of Nephrology,Lanzhou University First Hospital,Lanzhou 730000,China;Department of Pathology,School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院肾内科,甘肃兰州730000 [2]兰州大学基础医学院病理学研究所,甘肃兰州730000

出　　处：《临床荟萃》2019年第5期431-435,共5页Clinical Focus

基　　金：甘肃省自然科学研究基金计划——糖尿病肾病进展中足细胞Nephrin的表达及其对足细胞结构和功能的影响(1208RJZA232)

摘　　要：目的分析糖尿病肾病患者肾脏组织及尿液中nephrin表达与临床预后的相关性。方法经肾活检诊断为2型糖尿病肾病患者32例,用直接免疫荧光法检测肾脏组织nephrin表达,酶联免疫吸附测定(ELISA)法检测尿液nephrin表达水平,观察nephrin表达与临床预后的关系。结果糖尿病肾病组肾脏nephrin表达较正常对照组明显减少,尿nephrin/尿肌酐比值较正常对照组明显升高。根据肾脏nephrin表达水平分成高表达组和低表达组,低表达组糖尿病病程较长、糖化血红蛋白更高、白蛋白及eGFR较低、24小时尿蛋白定量及血肌酐较高,尿nephrin/肌酐值比值较高(P均<0.01)。同时也发现低表达组肾脏肾小球、肾小管间质、间质炎症及动脉硬化病变均较高表达组严重(P<0.01)。糖化血红蛋白升高与nephrin损伤有相关性,nephrin损伤与尿蛋白增多、eGFR下降有显著相关性。两组间肾脏生存率差异有统计学意义(P<0.01)。采用单因素COX相关回归分析提示肾脏nephrin表达量下降,尿液nephrin排泄增加是肾脏预后不良的影响因素。结论糖尿病肾病患者肾脏nephrin蛋白及尿液nephrin蛋白检测有助于糖尿病病情及预后判断。ObjectiveTo investigate the correlation between nephrin and prognosis of patients with diabetic nephropathy(DN).MethodsThirty-two patients with DN underwent renal biopsy and were diagnosed.Their nephrin in kidney was detected by direct immunofluorescence assay,nephrin in urine was detected by ELISA.The relationship of renal nephrin and urine nephrin and clinical prognosis were analyzed.ResultsThe expression of nephrin in the kidney of DN group was significantly lower than that of normal group.The urinary nephrin/creatinine ratio in DN group was higher than that of normal group.According to the level of nephrin in the kidney,the patients were divided into two groups:high nephrin group and low nephrin group.The low nephrine group suffered longer duration of diabetes mellitus,a higher level of glycosylated hemoglobin,lower level of albumin and eGFR,a higher level of urinary protein,serum creatinine and urinary nephrin/creatinine excretion ratio (all P < 0.01 ).The low nephrin group showed more significant interstitial fibrosis,tubular atrophy,interstitial inflammation,and arteriosclerosis( P < 0.01 ).The increase of HbA 1c was correlated with nephrin injury,whereas the nephrin injury significantly correlated with the increase of urine protein and the decrease of eGFR.There was a significant difference in renal survival between the two groups ( P < 0.01 ).COX proportional hazards regression analysis showed that decreased nephrin expression in the kidney and increased nephrin excretion in urine significantly influence renal survival.ConclusionThe detection of nephrin in the kidney and urine of DN patients helps to judge the condition and prognosis of DN.

关 键 词：糖尿病肾病 足细胞 酶联免疫吸附测定 预后 

分 类 号：R587.2[医药卫生—内分泌] R692[医药卫生—内科学]