血尿NGAL、尿RBP在小儿紫癜性肾炎早期临床诊断中的价值

发布时间：2018-03-09 10:18

  本文选题：过敏性紫癜　切入点：紫癜性肾炎　出处：《泸州医学院》2014年硕士论文　论文类型：学位论文

【摘要】：1.目的：研究各组患儿体内血尿中性粒细胞明胶酶相关载脂蛋（Urinaryand Serum Neutrophil Gelatinase-Associated Lipocalin, uNGAL andsNGAL）和尿视黄醇结合蛋白（Urinary Retinol Binding Protein, uRBP）、三项指标的水平及其之间的相关性，以及其预示小儿过敏性紫癜肾损伤的敏感性是否高于尿微量白蛋白、尿β2微球蛋白。方法：选初次罹患HSP患儿60例为实验组，30例同期在本院门诊体检的正常健康儿童作为正常对照组,其年龄、性别与实验组相匹配。实验组所有患儿于入院当日输液前均抽取2ml静脉血离心后取上清液，置-80℃冰箱冻存待测sNGAL。入院次日清晨取患儿晨尿10ml，置无内毒素及致热原的试管中，离心后分装EP管内并置-80℃冰箱冻存待测uNGAL、uRBP、尿微量白蛋白（urinemicroalbumin，uMA）、尿β2微球蛋白（urine β2microglobulin，uβ2-MG）。其后根据uMA、uβ2-MG结果将所有实验组HSP患儿再分为Ⅰ.过敏性紫癜无肾损害组（non-HSPN组）26例，Ⅱ.过敏性紫癜肾损害组（即紫癜性肾炎组,HSPN组）34例。所有正常对照组儿童均在门诊空腹当日抽取2ml静脉血及取晨尿10ml，处理方法同实验组。本研究还对实验组患儿临床治愈出院后半个月进行随访，设为过敏性紫癜无肾损害随访组（non-HSPN随访组）及HSPN随访组。所有随访患儿均检测sNGAL、uNGAL、uRBP、uMA、uβ2-MG；并与正常对照组、non-HSPN组、HSPN组进行比较。结果：1. non-HSPN组的uNGAL、sNGAL、uRBP、uMA、uβ2-MG等各项指标的均数±标准差分别为（0.1370±0.0256）mg/L、（0.1566±0.0386）mg/L、（0.786±0.123）mg/L、（10.44±2.33）mg/L、（0.171±0.047）mg/L；HSPN组中上述各指标的均数±标准差分别为（0.1370±0.0256）mg/L、（0.1566±0.0386）mg/L、（1.430±0.342）mg/L、（37.19±9.84）mg/L、（0.704±0.204）mg/L；正常组的上述各项指标均数±标准差分别为（0.0108±0.0029）mg/L、（0.0499±0.0206）mg/L、（0.166±0.054）mg/L、（9.39±1.17）mg/L、（0.157±0.019）mg/L。HSPN组的各项指标均较non-HSPN组明显增高，差异有统计学意义（P值均0.001）。non-HSPN组中uNGAL、sNGAL、uRBP较正常组增高，差异有统计学意义（P0.01）；HSPN随访组中的uNGAL、sNGAL、uRBP仍持续较高的水平，较正常组明显增高，有统计学意义（P0.01）。non-HSPN随访组中的uNGAL、sNGAL、uRBP较正常对照组增高，，差异有统计学意义（P0.01）。2.根据相关性研究发现此六项检测指标之间都具有相关性，各组内sNGAL与uNGAL、uRBP、uMA、uβ2-MG呈正相关，有统计学意义（P0.01）；uNGAL与sNGAL、uRBP、uMA、uβ2-MG呈正相关（P0.01）；uRBP与uNGAL、sNGAL、uMA、uβ2-MG呈正相关关系（P0.01）。研究推测血uNGAL、uRBP、sNGAL的水平在各组中随着uMA、uβ2-MG的增高而增高。结论：1.过敏性紫癜中不管是否存在肾损害，sNGAL、uNGAL、uRBP的水平明显高于正常对照组，且其水平随着患儿肾损害程度加重而逐渐增高。2.两随访组中sNGAL、uNGAL、 uRBP水平明显高于正常组，因此它们可用于过敏性紫癜患儿随访肾功能的检测指标。3.uNGAL、sNGAL、uRBP对过敏性紫癜早期肾损害的预测敏感性优于uMA、uβ2-MG，且出现的时间较uMA、uβ2-MG早。4.上述各项检测指标的联合应用能够提高判断过敏性紫癜患儿早期肾损害的准确率。
[Abstract]:1. Objective: To study the serum in vivo urine neutrophil gelatinase associated lipocalin (Urinaryand Serum Neutrophil Gelatinase-Associated Lipocalin egg, uNGAL andsNGAL) and urinary retinol binding protein (Urinary Retinol Binding Protein, uRBP), three indicators of the level and the correlation between the sensitivity and the allergic purpura kidney damage in children is higher than that of the urine albumin, urine beta 2 microglobulin. Methods: the first incidence of 60 HSP patients as the experimental group, 30 cases of healthy children in outpatient medical examination in our hospital as the control group, the age, gender matched with the experimental group. The experimental group of all patients on admission were collected 2ml venous blood transfusion before centrifugation the supernatant after -80 deg.c, refrigerator freezing test sNGAL. the next morning of admission from children urinary 10ml, the endotoxin and pyrogen test tube, after centrifugation URBP packaging EP tube collocated -80 C refrigerator uNGAL cryopreservation, measured urinary albumin (urinemicroalbumin, uMA), urine beta 2 microglobulin (urine beta 2microglobulin, u beta 2-MG). According to uMA, u beta 2-MG all of the experimental group HSP were divided into 1. Allergic purpura without renal damage group (non-HSPN group) 26 cases of allergic purpura kidney damage group (i.e. purpura nephritis group, HSPN group) 34 cases of normal control group. All children were in outpatient day fasting venous blood and collected 2ml urine samples of 10ml treated in the same way as the experimental group. The patients in the experimental group were cured from the second half of the month were followed up for allergic purpura without renal damage in follow-up group (non-HSPN group and HSPN group were followed up). All patients were followed up for detection of sNGAL, uNGAL, uRBP, uMA, u and beta 2-MG; and the normal control group, non-HSPN group and HSPN group were compared. Results: 1. non-HSPN group uNGAL, sNGAL, uRB P,uMA,u尾2-MG绛夊悇椤规寚鏍囩殑鍧囨暟卤鏍囧噯宸�鍒嗗埆涓�(0.1370卤0.0256)mg/L,(0.1566卤0.0386)mg/L,(0.786卤0.123)mg/L,(10.44卤2.33)mg/L,(0.171卤0.047)mg/L锛汬SPN缁勪腑涓婅堪鍚勬寚鏍囩殑鍧囨暟卤鏍囧噯宸�鍒嗗埆涓�(0.1370卤0.0256)mg/L,(0.1566卤0.0386)mg/L,(1.430卤0.342)mg/L,(37.19卤9.84)mg/L,(0.704卤0.204)mg/L锛涙�ｅ父缁勭殑涓婅堪鍚勯」鎸囨爣鍧囨暟卤鏍囧噯宸�鍒嗗埆涓

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