尿NGAL与IgA肾病早期诊断及预后的关系  

Association of urinary NGAL and early diagnosis and prognosis of IgA nephropathy

作　　者：史佳佳 朱国贞[1,2] SHI Jia-jia;ZHU Guo-zhen(Shanxi Medical University,Taiyuan,Shanxi 030001,China)

机构地区：[1]山西医科大学,山西太原030001 [2]山西医科大学第二医院肾内科,山西太原030001

出　　处：《中国临床研究》2023年第2期266-270,共5页Chinese Journal of Clinical Research

基　　金：山西省国际科技合作项目(2015081036)。

摘　　要：目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在IgA肾病早期诊断中的价值及其与IgA肾病患者肾脏累积存活率的关系。方法病例组为山西医科大学第二医院2017年3月至2018年7月经肾穿刺活检确诊的原发性IgA肾病患者39例,对照组为同期健康体检者55例。收集所有对象一般及临床资料并对其行尿NGAL检测。将IgA肾病患者按照肾小管间质损伤面积占比分为轻度、中度和重度组;按照尿NGAL中位数分为尿NGAL高、低水平组。比较各组尿NGAL水平;分析尿NGAL、尿肾损伤分子-1(KIM-1)对IgA肾病的早期诊断效能;分析尿NGAL与各临床指标的相关性;比较不同尿NGAL水平组及不同程度肾小管间质损伤组间的肾脏累积存活率。结果病例组与对照组之间及不同程度肾小管间质损伤组之间,尿NGAL水平差异有统计学意义(P<0.05)。ROC曲线显示,尿NGAL对IgA肾病早期诊断的曲线下面积(AUC=0.809)大于尿KIM-1的曲线下面积(AUC=0.746)。Spearman相关性分析显示,IgA肾病患者尿NGAL与尿中KIM-1、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、视黄醇结合蛋白(RBP)、α1-微球蛋白(α1-MG)、血清肌酐(SCr)及24 h尿蛋白定量呈正相关(P<0.05),与肾小球滤过率(eGFR)呈负相关(P<0.05)。Kaplan-Meier生存分析显示,尿NGAL高水平组IgA肾病患者的肾脏累积存活率低于尿NGAL低水平组,重度肾小管间质损伤组IgA肾病患者的肾脏累积存活率低于轻、中度肾小管间质损伤组(P<0.05)。结论尿NGAL检测在IgA肾病的早期诊断及预后评估方面具有一定的临床应用价值。Objective To investigate the value of urinary neutrophil gelatinase-associated lipocalin(NGAL)in the early diagnosis of IgA nephropathy and its relationship with the cumulative survival rate of kidney in patients with IgA nephropathy.Methods The case group consisted of 39 patients with primary IgA nephropathy diagnosed by renal biopsy in the Second Hospital of Shanxi Medical University from March 2017 to July 2018,and the control group consisted of 55 healthy people in the same period.Patients with IgA nephropathy were divided into mild,moderate and severe groups according to the proportion of renal tubulointerstitial injury area,and into high and low urinary NGAL groups according to the median urine NGAL.The levels of urinary NGAL in each group were compared.To analyze the early diagnostic efficacy of urine NGAL and urine kidney injury molecule-1(KIM-1)for IgA nephropathy.The correlation between urinary NGAL and various clinical indicators was analyzed.The cumulative survival rate of the kidney was compared among groups with different urinary NGAL levels and groups with different degrees of tubulointerstitial injury.Results There were statistically significant differences in urinary NGAL levels between the case group and the control group,as well as between groups with different degrees of tubulointerstitial injury(P<0.05).ROC curve showed that the area under the curve(AUC=0.809)of urine NGAL for the early diagnosis of IgA nephropathy was larger than that of urine KIM-1(AUC=0.746).In Spearman's correlation analysis,urine NGAL of IgA nephropathy patients showed a positive correlation with urine KIM-1,N-acetyl-β-D-glucosaminidase(NAG),retinol binding protein(RBP),α1-microglobulin(α1-MG),serum creatinine(SCr)and 24-h urine protein quantitation(P<0.05),and a negative correlation with estimated glomerular filtration rate(eGFR)(P<0.05).Kaplan-Meier survival analysis showed that the cumulative renal survival rate of patients with IgA nephropathy in the urine high level group of NGAL was lower than that in the urine

关 键 词：IGA肾病 中性粒细胞明胶酶相关脂质运载蛋白 肾损伤因子1 早期诊断 肾脏累积存活率 

分 类 号：R492.6[医药卫生—康复医学]