中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
Chinese Journal of Nephrology
2015年
10期
721-728
,共8页
戴如凤%方晓燕%李国民%刘海梅%翟亦晖%沈茜%孙利%徐虹
戴如鳳%方曉燕%李國民%劉海梅%翟亦暉%瀋茜%孫利%徐虹
대여봉%방효연%리국민%류해매%적역휘%침천%손리%서홍
血管生成素类%肾病综合征%儿童
血管生成素類%腎病綜閤徵%兒童
혈관생성소류%신병종합정%인동
Angiopoietins%Nephrotic syndrome%Child
目的 初步探讨血清与尿液中血管生成素样蛋白3(ANGPTL3)和4(ANGPTL4)在原发性肾病综合征(PNS)中的临床意义.方法 收集2012年9月至2013年8月复旦大学附属儿科医院肾脏风湿科PNS住院患儿180例为研究对象,纳入健康体检儿童18例为对照组.运用酶联免疫吸附法(ELISA)检测血清及尿液样本中ANGPTL3和4的浓度;采用全自动生化分析仪检测尿蛋白(Up)、尿肌酐(Ucr)、血肌酐(Scr)、血尿素氮(BUN)、三酰甘油(TG)及总胆固醇(TC)浓度;采用SPSS 19.0软件进行统计分析.结果 (1)PNS患儿血ANGPTL3的水平高于健康儿童[1210.95(671.28 ～ 1571.87) μg/L比308.20(230.05 ～ 372.26) μg/L,P＜0.01];PNS患儿尿ANGPTL4/Cr的水平高于健康儿童[115.57 (26.50～ 129.81) ng/g比11.26(2.23～15.11)ng/g,P＜0.01];PNS患儿尿ANGPTL3/Cr值及血ANGPTL4水平与健康儿童相比差异均无统计学意义.(2)PNS患儿组血ANGPTL3水平和发病年龄(r=0.199,P=0.047)、病程(r=0.501,P=0.027)、24 h尿蛋白量(r=0.384,P=0.004)、Up/Ucr (r=0.367,P=0.006)、TG(r=0.314,P=0.021)及TC(r=0.444,P=0.001)呈正相关;控制血脂因素后,PNS患儿血ANGPTL3仍与24 h尿蛋白量(r=0.348,P＜0.001)、Up/Ucr(r=0.312,P＜0.001)呈正相关;尿ANGPTL4/Cr与24h尿蛋白量(r=0.318,P=0.019)及Up/Ucr(r=0.117, P=0.044)呈正相关.(3)ANGPTL3和ANGPTL4水平与PNS激素治疗反应及复发情况无相关性,然而同一例激素依赖频复发NS患儿在激素治疗的不同时期,血ANGPTL3水平变化与尿蛋白变化趋势一致.(4)在蛋白尿程度、血脂水平相对一致的前提下,PNS患儿中,病理类型不同,其血ANGPTL3水平也不同.结论 血ANGPTL3水平可能是反映PNS发病情况、蛋白尿程度、病理类型及激素药物治疗后蛋白尿转归的重要指标之一.尿ANGPTL4水平与PNS患儿尿蛋白水平正相关,可能也具有一定的临床参考价值.
目的 初步探討血清與尿液中血管生成素樣蛋白3(ANGPTL3)和4(ANGPTL4)在原髮性腎病綜閤徵(PNS)中的臨床意義.方法 收集2012年9月至2013年8月複旦大學附屬兒科醫院腎髒風濕科PNS住院患兒180例為研究對象,納入健康體檢兒童18例為對照組.運用酶聯免疫吸附法(ELISA)檢測血清及尿液樣本中ANGPTL3和4的濃度;採用全自動生化分析儀檢測尿蛋白(Up)、尿肌酐(Ucr)、血肌酐(Scr)、血尿素氮(BUN)、三酰甘油(TG)及總膽固醇(TC)濃度;採用SPSS 19.0軟件進行統計分析.結果 (1)PNS患兒血ANGPTL3的水平高于健康兒童[1210.95(671.28 ～ 1571.87) μg/L比308.20(230.05 ～ 372.26) μg/L,P＜0.01];PNS患兒尿ANGPTL4/Cr的水平高于健康兒童[115.57 (26.50～ 129.81) ng/g比11.26(2.23～15.11)ng/g,P＜0.01];PNS患兒尿ANGPTL3/Cr值及血ANGPTL4水平與健康兒童相比差異均無統計學意義.(2)PNS患兒組血ANGPTL3水平和髮病年齡(r=0.199,P=0.047)、病程(r=0.501,P=0.027)、24 h尿蛋白量(r=0.384,P=0.004)、Up/Ucr (r=0.367,P=0.006)、TG(r=0.314,P=0.021)及TC(r=0.444,P=0.001)呈正相關;控製血脂因素後,PNS患兒血ANGPTL3仍與24 h尿蛋白量(r=0.348,P＜0.001)、Up/Ucr(r=0.312,P＜0.001)呈正相關;尿ANGPTL4/Cr與24h尿蛋白量(r=0.318,P=0.019)及Up/Ucr(r=0.117, P=0.044)呈正相關.(3)ANGPTL3和ANGPTL4水平與PNS激素治療反應及複髮情況無相關性,然而同一例激素依賴頻複髮NS患兒在激素治療的不同時期,血ANGPTL3水平變化與尿蛋白變化趨勢一緻.(4)在蛋白尿程度、血脂水平相對一緻的前提下,PNS患兒中,病理類型不同,其血ANGPTL3水平也不同.結論 血ANGPTL3水平可能是反映PNS髮病情況、蛋白尿程度、病理類型及激素藥物治療後蛋白尿轉歸的重要指標之一.尿ANGPTL4水平與PNS患兒尿蛋白水平正相關,可能也具有一定的臨床參攷價值.
목적 초보탐토혈청여뇨액중혈관생성소양단백3(ANGPTL3)화4(ANGPTL4)재원발성신병종합정(PNS)중적림상의의.방법 수집2012년9월지2013년8월복단대학부속인과의원신장풍습과PNS주원환인180례위연구대상,납입건강체검인동18례위대조조.운용매련면역흡부법(ELISA)검측혈청급뇨액양본중ANGPTL3화4적농도;채용전자동생화분석의검측뇨단백(Up)、뇨기항(Ucr)、혈기항(Scr)、혈뇨소담(BUN)、삼선감유(TG)급총담고순(TC)농도;채용SPSS 19.0연건진행통계분석.결과 (1)PNS환인혈ANGPTL3적수평고우건강인동[1210.95(671.28 ～ 1571.87) μg/L비308.20(230.05 ～ 372.26) μg/L,P＜0.01];PNS환인뇨ANGPTL4/Cr적수평고우건강인동[115.57 (26.50～ 129.81) ng/g비11.26(2.23～15.11)ng/g,P＜0.01];PNS환인뇨ANGPTL3/Cr치급혈ANGPTL4수평여건강인동상비차이균무통계학의의.(2)PNS환인조혈ANGPTL3수평화발병년령(r=0.199,P=0.047)、병정(r=0.501,P=0.027)、24 h뇨단백량(r=0.384,P=0.004)、Up/Ucr (r=0.367,P=0.006)、TG(r=0.314,P=0.021)급TC(r=0.444,P=0.001)정정상관;공제혈지인소후,PNS환인혈ANGPTL3잉여24 h뇨단백량(r=0.348,P＜0.001)、Up/Ucr(r=0.312,P＜0.001)정정상관;뇨ANGPTL4/Cr여24h뇨단백량(r=0.318,P=0.019)급Up/Ucr(r=0.117, P=0.044)정정상관.(3)ANGPTL3화ANGPTL4수평여PNS격소치료반응급복발정황무상관성,연이동일례격소의뢰빈복발NS환인재격소치료적불동시기,혈ANGPTL3수평변화여뇨단백변화추세일치.(4)재단백뇨정도、혈지수평상대일치적전제하,PNS환인중,병리류형불동,기혈ANGPTL3수평야불동.결론 혈ANGPTL3수평가능시반영PNS발병정황、단백뇨정도、병리류형급격소약물치료후단백뇨전귀적중요지표지일.뇨ANGPTL4수평여PNS환인뇨단백수평정상관,가능야구유일정적림상삼고개치.
Objective To explore the clinical significance of the serum and urine angiopoietin (ANGPTL) 3 and 4 levels in children with primary nephrotic syndrome (PNS).Methods Serum and urine samples from 180 children with PNS admitted from September 2012 to August 2013,and from 18 healthy children as control, were analyzed.Serum and urine ANGPTL3 and 4 concentrations were detected by ELISA.Urine protein (Up), urine creatinine (Ucr), serum creatinine (Scr), blood urea nitrogen (BUN), triglyceride (TG) and total cholesterol (TC) levels were analyzed by automatic biochemical analyzer.Data were analyzed by SPSS 19.0.Results (1) Serum ANGPTL3 concentration in PNS children was higher than that in healthy children population [1210.95 (671.28-1571.87) μg/L vs 308.20 (230.05-372.26) μg/L, P ＜ 0.01];Urine ANGPTL4/Cr in PNS children was also higher than that in healthy children [115.57 (26.50-129.81) ng/g vs 11.26 (2.23-15.11) ng/g, P ＜0.01];Serum ANGPTL4 concentration and urine ANGPTL3/Cr in PNS children had no difference with those in healthy children population.(2) ANGPTL3 serum levels were positively correlated with age at onset (r=0.199, P=0.047), duration of disease (r=0.501, P=0.027), 24 h urine protein excretion (r=0.384, P=0.004), Up/Ucr (r=0.367, P=0.006), TG (r=0.314, P=0.021), and TC (r=0.444, P=0.001),while controlling the serum lipid level, serum ANGPTL3 level was also correlated with 24 h urine protein excretion (r=0.348, P＜0.001) and Up/Ucr (r=0.312, P＜0.001);Urine ANGPTL4/Cr was positively correlated with 24 h urine protein excretion (r=0.318, P=0.019), Up/Ucr (r=0.117, P=0.044).(3) No difference of serum and urine ANGPTL3 and 4 levels were found among steroid-sensitive, steroid -resistant, steroid-dependent PNS groups, as well as between the frequency relapse or non-frequency relapse groups, while in steroid-dependent and frequency relapse NS children, serum ANGPTL3 level could reflect the curative effect on proteinuria.(4) In PNS children with similar degree of proteinuria and lipid levels, the serum ANGPTL3 levels varied in different pathological types.Conclusions Serum ANGPTL3 level may be an important indicator of PNS incidence, disease severities, pathological types and curative effect on proteinuria in PNS.Urine ANGPTL4 level is correlated with proteinuria,which may have the clinical reference value in PNS.
