血清NGAL、β2-MG与IgA肾病病理分级及预后的相关性  

Correlation between serum NGAL,β2-MG and pathological grade,prognosis of IgA nephropathy

作　　者：张兆怡 王驰 常青 虞亚菲 董腾腾 聂飒飒 李绵洋 ZHANG Zhaoyi;WANG Chi;CHANG Qing;YU Yafei;DONG Tengteng;NIE Sasa;LI Mianyang(Graduate School of PLA Medical College,Beijing,China,100039;Laboratory Department,First Medi-cal Center of the General Hospital of the People's Liberation Army,Beijing,China,100853;Department of Nephrology,First Medical Center of the General Hospital of the People's Liberation Army,Beijing,China,100853)

机构地区：[1]解放军医学院研究生院,北京100039 [2]中国人民解放军总医院第一医学中心检验科,北京100853 [3]中国人民解放军总医院第一医学中心肾内科,北京100853

出　　处：《分子诊断与治疗杂志》2023年第4期554-558,共5页Journal of Molecular Diagnostics and Therapy

基　　金：国家重点研发计划科技部课题(2018YFC2000201)。

摘　　要：目的分析IgA肾病患者血清中性粒细胞明胶酶相关载脂蛋白(NGAL)、血β2-微球蛋白(β2-MG)水平与肾功能指标、Lee氏分级和牛津病理分级之间的相关性,并分析影响IgA肾病预后的因素。方法收集2020年9月至2022年7月在解放军总医院初次诊治,经肾穿刺活检术确诊为IgA肾病的患者190例。并检测血清NGAL、β2-MG水平,分析血清NGAL、β2-MG与IgA肾病肾功能指标相关性及对不同牛津病理分型诊断的效能;分析血清NGAL、β2-MG与IgA肾病患者预后关系。结果血清NGAL、β2-MG水平在不同肾小管萎缩/肾间质纤维化(T)、系膜细胞增生(M)组间比较差异有统计学意义(H=20.119,F=26.407,t=1.972、2.507,P<0.05),T1和T2组水平均高于T0组;M1组水平高于M0组。血清NGAL、β2-MG水平在不同Lee氏分级组间差异有统计学意义(F=28.672,H=63.626,P<0.05),Lee氏Ⅳ~Ⅴ级组血清NGAL、β2-MG水平高于Lee氏Ⅰ~Ⅱ级及LeeⅢ级组。β2-MG、NGAL与SCr、BUN、24 h尿蛋白分别呈正相关性,与eGFR呈负相关性;血清NGAL、β2-MG及二者联合检测可以对肾小管间质萎缩/间质纤维化(T)进行预测,ROC曲线下面积分别为0.705、0.710、0.738。单因素COX分析显示血清NGAL、β2-MG等指标是肾脏预后不良的危险因素,多因素COX回归分析结果显示肾小管萎缩/间质纤维化(T)、血红蛋白、24 h尿蛋白是肾脏不良预后的独立危险因素。结论血清NGAL、β2-MG与IgAN患者肾损伤程度密切相关,对评估肾小管萎缩/间质纤维化病理损伤更敏感,能反映肾小管间质的损伤程度。血清NGAL、β2-MG是肾脏预后不良的危险因素,肾小管萎缩/间质纤维化(T)、血红蛋白、24 h尿蛋白是肾脏不良预后的独立危险因素。Objective To analyze the correlation between serum neutrophil gelatinase-associated apolipoprotein(NGAL)and serum β2-microglobulin(β2-MG)levels and renal function indexes,Lee's grade and Oxford pathological grade in patients with IgA nephropathy(IgAN),and to analyze the effect of these indexes on the prognosis of IgA nephropathy.Methods From September 2020 to July 2022,a total of 190 patients with IgA nephropathy diagnosed by renal biopsy in PLA General Hospital were collected,and the serum levels of NGAL and β2-MG were detected.The correlation between serum NGAL and β2-MG and renal function indexes of IgA nephropathy and the diagnostic effectiveness of different Oxford pathological types were analyzed.The relationship between serum NGAL,β2-MG and prognosis of patients with IgA nephropathy were also analyzed.Results There were significant differences in serum NGAL and β2-MG levels among different renal tubule atrophy/renal interstitial fibrosis(T)and mesangial cell hyperplasia(M)groups(H=20.119,F=26.407,t=1.972、2.507,P<0.05).The levels of NGAL and β2-MG in the T1 and T2 groups were higher than those in the T0 group,and the M1 group was higher than that in the M0 group.The levels of serum NGAL andβ2-MG were significantly different among the different Lee's grade groups(F=28.672,H=63.626,P<0.05).The levels of serum NGAL and β2-MG in the Lee's Ⅳ-Ⅴ group were higher than those in the Lee's Ⅰ-Ⅱ and LeeⅢ groups.β2-MG,NGAL were positively correlated with SCr,BUN,and 24 h urine protein respectively,and negatively correlated with e GFR.The combined detection of serum NGAL,β2-MG could diagnose renal tubulointerstitial atrophy/interstitial fibrosis(T),with the areas under the ROC curve of 0.705,0.710 and0.738,respectively.Univariate COX analysis showed that serum NGAL,β2-MG and other indicators were risk factors for poor renal prognosis.Multivariate COX regression analysis showed that renal tubular atrophy/interstitial fibrosis,hemoglobin and 24 h urinary protein were independent risk factors for poo

关 键 词：IGA肾病 病理分型 血清NGAL 血Β2-微球蛋白 

分 类 号：R692.31[医药卫生—泌尿科学]