血清NGAL、Cystatin C与慢性肾小球肾炎病理的相关性研究  

Study on the correlation between serum NGAL,Cystatin C and the pathological mechanism of chronic glomerulonephritis

作　　者：孙蔚倩[1] 胡屏[1] 贺海东[1] 唐余燕 吴佳君[1] 徐旭东[1] SUN Weiqian;HU Ping;HE Haidong;TANG Yuyan;WU Jiajun;XU Xudong(Department of Nephrology,Minhang Hospital Affiliated to Fudan University/Shanghai Minhang District Central Hospital,Shanghai 201199,China)

机构地区：[1]复旦大学附属闵行医院/上海市闵行区中心医院肾脏科,上海201199

出　　处：《重庆医学》2020年第19期3211-3215,3219,共6页Chongqing medicine

基　　金：国家自然科学基金项目(81774060);上海市闵行区中心医院院级课题项目(2017MHLC09);上海市闵行区自然科学基金项目(2019MHZ056)。

摘　　要：目的探讨慢性肾小球肾炎(CGN)患者的血清中性粒细胞明胶酶相关载脂蛋白(NGAL)、半胱氨酸蛋白酶抑制剂C(Cystatin C)水平与其肾脏病理的相关性。方法选择初次诊治经肾穿刺,病理诊断符合CGN的患者34例,根据CKD-EPI公式计算肾小球滤过率(eGFR),根据eGFR结果分为eGFR正常组23例(eGFR>90 mL/min)和低eGFR组11例(eGFR 60~90 mL/min),同时选取15例健康体检者作为对照组。应用ELISA法检测血清NGAL和Cystatin C水平,分析其与肾脏病理之间的相关性;应用受试者操作特征(ROC)曲线评估血清NGAL对CGN病理改变的敏感度。结果CGN组患者血清NGAL、Cystatin C水平均高于健康对照组,且与eGFR呈负相关(r=0.442、0.696,P<0.01)。组间配对t检验发现,eGFR下降的CGN组血清NGAL高于eGFR健康对照组(P<0.05)。ROC曲线表明,血清NGAL反映早期肾小球病变的敏感度优于Cystatin C,ROC曲线下面积分别为0.670和0.358,血清NGAL评估肾脏小管间质损伤的敏感度更高于其他指标。结论血清NGAL、Cystatin C与eGFR密切相关,血清NGAL评估CGN的病理损伤更敏感,更能反映肾小管间质损伤的损伤程度。Objective To explore the relationship between serum levels of serum neutrophil gelatinase-associated lipocalin(NGAL)and Cystatin C and pathological features of chronic glomerulonephritis(CGN).Methods A total of 34 cases of biopsy proven chronic glomerulonephritis without immunosuppression therapy were enrolled in the study.Calculate glomerular filtration rate(eGFR)by formula(CKD-EPI).Under the results of eGFR,the patients were divided into two groups,normal eGFR group(eGFR>90 mL/min,n=23)and declining eGFR group(eGFR<90 mL/min,n=11),at the same time,15 healthy subjects were selected as the control group.Use ELISA method to detect serum NGAL and Cystatin C values,and analyze their correlation with renal pathology;Use ROC curve to evaluate the sensitivity of serum NGAL to the pathological changes of chronic glomerulonephritis.Results NGAL and Cystatin C in CGN group were higher than healthy persons(P<0.05),NGAL and Cystatin C were negatively correlated with eGFR(r=-0.442 and-0.696,P<0.01).Paired t-test between groups found that the serum NGAL of the declining eGFR group was higher than that of the normal eGFR group(P<0.05).ROC indicated that NGAL was more sensitivity on reflecting the pathological lesions,the areas under ROC curve were 0.670,0.358 respectively.Conclusion NGAL and Cystatin C were closely related with eGFR.NGAL was more sensitivity and specific on reflecting the pathological lesions in CGN,especially in renal tubule and interstitial.The results suggested that NGAL could be sensitivity markers to evaluate renal damage in CGN.

关 键 词：中性粒细胞明胶酶相关载脂蛋白 半胱氨酸蛋白酶抑制剂C 慢性肾小球肾炎 肾脏病理 

分 类 号：R692.31[医药卫生—泌尿科学]