不同类型慢性肾病患者血清游离轻链表达及对预后判断的价值  

Expression of serum free immunoglobulin light chains in patients with different types of chronic kidney disease and its value in monitoring prognosis

作　　者：李春梅 缪卫华[1] 张梅香[1] 李丽霞[1] 唐汝新[1] 杜海珍[2] Li Chunmei;Miu Weihua;Zhang Meixiang;Li Lixia;Tang Ruxin;Du Haizhen(Laboratory Medical Center,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China;Laboratory Department,Zhongda Hospital Affiliated to Southeast University,Nanjing 210003,China)

机构地区：[1]南京医科大学第二附属医院检验医学中心,210000 [2]东南大学附属中大医院检验科,南京210003

出　　处：《国际免疫学杂志》2019年第6期594-598,共5页International Journal of Immunology

摘　　要：目的探讨不同类型慢性肾病(chronic kidney disease,CKD)患者的血清游离轻链(serumfree light chains,sFLC)表达水平及其在预后判断中的应用价值.方法收集2015年1月至2018年8月南京医科大学第二附属医院和东南大学附属中大医院收治的CKD患者323例(观察组),根据病理类型分为原发性肾小球病(A组,n=187),继发性肾小球病(B组,n=65),肾小管-间质疾病(C组,n=25),肾血管病(D组,n=46).另选健康体检者40例为对照组.比较各组的sFLCκ、λ、κ/λ值,并分析不同分期、不同预后CKD患者的sFLCκ、λ、κ/λ值的不同.结果观察组的sFLCκ、λ、κ/λ值均低于对照组[(11.43±1.41)比(8.02±1.13),(5.52±1.15)比(4.43±0.85),(2.07±0.47)比(1.81±0.31),P值均<0.05)];A、B、C、D组的sFLCκ、λ、κ/λ值均低于对照组(P值均<0.05),但四组间差异无统计学意义(P>0.05);随着CKD分期的变化,sFLCκ、λ、κ/λ值呈降低趋势,以5期患者最低(P<0.05);随访后,肾功能恶化患者的sFLCκ、λ、κ/λ值降低率高于肾功能稳定患者(P<0.05).结论不同因素所致CKD患者存在sFLCκ、λ水平降低,且与肾功能进展有关,低水平sFLCκ、λ可能提示预后不良或肾功能恶化.Objective To investigate the expression of serum free light chains(sFLC)in patients with different types of chronic kidney disease(CKD)and its value in monitoring prognosis.Methods Three hundred and twenty-three cases of CKD patients admitted to the Second Affiliated Hospital of Nanjing Medical University and Zhongda Hospital Affiliated to Southeast University from January 2015 to August 2018 were enrolled as observation group.According to the pathological type,the cases were divided into primary glomerular disease group(group A,n=187),secondary renal small bacterial disease group(group B,n=65),tubulo-interstitial disease group(group C,n=25),and renal vascular disease group(group D,n=46).Another 40 healthy subjects were selected as the control group.The sFLCκ,λ,κ/λvalue of each group were compared,and the sFLCκ,λ,κ/λvalues of CKD patients with different stages and different prognosis were analyzed.Results The values of sFLCκ,λandκ/λin the observation group were lower than those in the control group[(11.43±1.41)vs(8.02±1.13),(5.52±1.15)vs(4.43±0.85),(2.07±0.47)vs(1.81±0.31)],differences were statistically significant(all P<0.05);the values of sFLCκ,λandκ/λin the A,B,C and D groups were lower than those in the control group differences(P<0.05),but there was no significant difference between the four groups(P>0.05).With the increase of CKD stage,the sFLCκ,λ,κ/λvalues decreased,the lowest in patients with stage 5(P<0.05).After follow-up,the reduction rate of sFLCκ,λ,κ/λin the renal function deterioration group was significantly higher than that in the renal function stabilization group(P<0.05).Conclusion Levels of sFLCκandλin patients with CKD caused by different factors may significantly decrease and should be more apparent with renal function progresses.Lower sFLCκandλlevels be associated with high risk of poor prognosis or deterioration of renal function.

关 键 词：慢性肾病 免疫球蛋白 游离轻链 预后 

分 类 号：R69[医药卫生—泌尿科学]