中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2013年
7期
493-497
,共5页
张颖%唐敏%施婧%杨晶%李胜开%尹忠诚
張穎%唐敏%施婧%楊晶%李勝開%尹忠誠
장영%당민%시청%양정%리성개%윤충성
肾病综合征%急性肾损伤%中性粒细胞明胶酶相关脂质运载蛋白
腎病綜閤徵%急性腎損傷%中性粒細胞明膠酶相關脂質運載蛋白
신병종합정%급성신손상%중성립세포명효매상관지질운재단백
Nephrotic syndrome%Acute kidney injury%Neutrophil gelatinase-associated lipocalin
目的 探讨原发性肾病综合征(PNS)患者中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的变化以及与病理类型、肾小管间质损伤程度、临床指标的关系. 方法 40例PNS患者按有无急性肾小管坏死(ATN)分急性肾损伤(AKI)组及非AKI组,按病理类型分微小病变型肾病(MCD)组、系膜增生性肾小球肾炎(MsPGN)组、局灶性节段性肾小球硬化(FSGS)组、膜增生性肾小球肾炎(MPGN)组、膜性肾病(MN)组；20例健康体检者及20例因肾肿瘤做肾切除术但远离肿瘤部位的正常肾组织作正常对照.采用酶联免疫吸附试验(ELISA)法检测血清、尿液NGAL水平,免疫组织化学染色法观察肾组织NGAL表达.结果 (1) AKI组患者血、尿NGAL水平及肾组织NGAL表达显著高于非AKI组及对照组(P＜0.05).(2)MPGN组及FSGS组患者血、尿NGAL水平及肾组织NGAL表达显著高于其他病理类型组(P＜0.05).(3)在肾小管间质发展至重度病变之前,随着肾小管间质损伤程度的加重,血、尿NGAL水平及肾组织NGAL表达逐渐升高；在肾小管间质发展至重度病变时,血NGAL水平及肾组织NGAL表达下降(P＜0.05).(4)血、尿NGAL水平及肾组织NGAL表达与血肌酐呈正相关(r值分别为0.198、0.352、0.146,P值分别为0.048、0.000、0.028),与尿素氮呈正相关(r值分别为0.199、0.278、0.325,P值分别为0.043、0.000、0.019),与血白蛋白呈负相关(r值分别为-0.384、-0.318、-0.259,P值分别为0.028、0.024、0.020),与尿渗透浓度呈负相关(r值分别为-0.250、-0.256、-0.277,P值分别为0.012、0.027、0.002).结论 NGAL可作为预测PNS患者AKI的敏感指标,在一定程度下可用于评价肾小管间质病变程度及肾功能.
目的 探討原髮性腎病綜閤徵(PNS)患者中性粒細胞明膠酶相關脂質運載蛋白(NGAL)的變化以及與病理類型、腎小管間質損傷程度、臨床指標的關繫. 方法 40例PNS患者按有無急性腎小管壞死(ATN)分急性腎損傷(AKI)組及非AKI組,按病理類型分微小病變型腎病(MCD)組、繫膜增生性腎小毬腎炎(MsPGN)組、跼竈性節段性腎小毬硬化(FSGS)組、膜增生性腎小毬腎炎(MPGN)組、膜性腎病(MN)組；20例健康體檢者及20例因腎腫瘤做腎切除術但遠離腫瘤部位的正常腎組織作正常對照.採用酶聯免疫吸附試驗(ELISA)法檢測血清、尿液NGAL水平,免疫組織化學染色法觀察腎組織NGAL錶達.結果 (1) AKI組患者血、尿NGAL水平及腎組織NGAL錶達顯著高于非AKI組及對照組(P＜0.05).(2)MPGN組及FSGS組患者血、尿NGAL水平及腎組織NGAL錶達顯著高于其他病理類型組(P＜0.05).(3)在腎小管間質髮展至重度病變之前,隨著腎小管間質損傷程度的加重,血、尿NGAL水平及腎組織NGAL錶達逐漸升高；在腎小管間質髮展至重度病變時,血NGAL水平及腎組織NGAL錶達下降(P＜0.05).(4)血、尿NGAL水平及腎組織NGAL錶達與血肌酐呈正相關(r值分彆為0.198、0.352、0.146,P值分彆為0.048、0.000、0.028),與尿素氮呈正相關(r值分彆為0.199、0.278、0.325,P值分彆為0.043、0.000、0.019),與血白蛋白呈負相關(r值分彆為-0.384、-0.318、-0.259,P值分彆為0.028、0.024、0.020),與尿滲透濃度呈負相關(r值分彆為-0.250、-0.256、-0.277,P值分彆為0.012、0.027、0.002).結論 NGAL可作為預測PNS患者AKI的敏感指標,在一定程度下可用于評價腎小管間質病變程度及腎功能.
목적 탐토원발성신병종합정(PNS)환자중성립세포명효매상관지질운재단백(NGAL)적변화이급여병리류형、신소관간질손상정도、림상지표적관계. 방법 40례PNS환자안유무급성신소관배사(ATN)분급성신손상(AKI)조급비AKI조,안병리류형분미소병변형신병(MCD)조、계막증생성신소구신염(MsPGN)조、국조성절단성신소구경화(FSGS)조、막증생성신소구신염(MPGN)조、막성신병(MN)조；20례건강체검자급20례인신종류주신절제술단원리종류부위적정상신조직작정상대조.채용매련면역흡부시험(ELISA)법검측혈청、뇨액NGAL수평,면역조직화학염색법관찰신조직NGAL표체.결과 (1) AKI조환자혈、뇨NGAL수평급신조직NGAL표체현저고우비AKI조급대조조(P＜0.05).(2)MPGN조급FSGS조환자혈、뇨NGAL수평급신조직NGAL표체현저고우기타병리류형조(P＜0.05).(3)재신소관간질발전지중도병변지전,수착신소관간질손상정도적가중,혈、뇨NGAL수평급신조직NGAL표체축점승고；재신소관간질발전지중도병변시,혈NGAL수평급신조직NGAL표체하강(P＜0.05).(4)혈、뇨NGAL수평급신조직NGAL표체여혈기항정정상관(r치분별위0.198、0.352、0.146,P치분별위0.048、0.000、0.028),여뇨소담정정상관(r치분별위0.199、0.278、0.325,P치분별위0.043、0.000、0.019),여혈백단백정부상관(r치분별위-0.384、-0.318、-0.259,P치분별위0.028、0.024、0.020),여뇨삼투농도정부상관(r치분별위-0.250、-0.256、-0.277,P치분별위0.012、0.027、0.002).결론 NGAL가작위예측PNS환자AKI적민감지표,재일정정도하가용우평개신소관간질병변정도급신공능.
Objective To discuss the changes of neutrophil gelatinase-associated lipocalin (NGAL) in patients with primary nephrotic syndrome (PNS)and the correlation with renal pathological type,renal tubulointerstitial lesions and the clinical indicators.Methods Forty patients with PNS were divided into acute kidney injury (AKI) group and non-AKI group according to whether renal tubular necrosis (ATN) occurred in renal pathology.Moreover,on the basis of pathological type they were divided into minimal change disease (MCD) group,mesangial proliferative glomerulonephritis (MsPGN) group,focal segmental glomerulosclerosis (FSGS) group,membrane proliferative glomerulonephritis (MPGN) group and membranous nephropathy (MN) group.Twenty healthy subjects and normal kidney tissues which came from 20 patients with renal tumor nephrectomy and were distant from the tumor sites were the control groups.Enzyme-linked immunosorbent assay (ELISA) was applied to detect the serum and urine level of NGAL,and immunohistochemical staining was used to observe the expression of NGAL in the renal tissue.Results (1)The serum and urine level of NGAL and the expression of NGAL in the renal tissue in the PNS complicated with AKI group were significantly higher than that in the PNS without AKI group and in the control group(P ＜ 0.05).(2)The serum and urine level of NGAL and the expression of NGAL in the renal tissue were enhanced in MPGN group and FSGS group than that in the other three groups(P ＜ 0.05).(3) Before developing to severe tubulointerstitial lesions,with the aggravation of tubulointerstitial damage,the serum and urine level of NGAL and the expression of NGAL in the renal tissue were increased.But when renal tubular interstitial lesions developed to severe disease,serum level of NGAL and the expression of NGAL in the renal tissue were decreased(P ＜ 0.05).(4)The serum and urine level of NGAL and the expression of NGAL in the renal tissue were positively correlated with serum creatinine(r values were 0.198,0.352,0.146 respectively,P values were 0.048,0.000,0.028 respectively),were positively correlated with blood urea nitrogen(r values were 0.199,0.278,0.325 respectively,P values were 0.043,0.000,0.019 respectively),were negatively correlated with serum albumin(r values were-0.384,-0.318,-0.259 respectively,P values were 0.028,0.024,0.020 respectively) and were negatively correlated with urine osmotic pressure(r values were-0.250,-0.256,-0.277 respectively,P values were 0.012,0.027,0.002 respectively).Conclusion NGAL is a sensitive biological parameter for predicting AKI in the patients with PNS,and it can be used to evaluate the degree of tubulointerstitial lesions and renal function to a certain extent.
