原发性肾病综合征患儿尿MCP-1、IL-18的检测及临床意义

发布时间：2018-06-12 05:27

本文选题：原发性肾病综合征 + MCP-1　；参考：《山西医科大学》2012年硕士论文

【摘要】：目的：检测原发性肾病综合征(PNS)患儿不同时间点尿液中单核细胞趋化蛋白-1(MCP-1)、白介素-18(IL-18)的含量,探讨其与PNS的发生、发展、反复及预后有无相关性,寻找相对特异和敏感的生物学标记物为临床治疗原发性肾病综合征及判断其预后提供线索。方法：选取本院住院的65例PNS患儿为研究对象,根据对激素效应及随访结果分为三组：激素敏感型肾病综合征(SSNS)35例,激素耐药型肾病综合征(SRNS)15例,频反复肾病综合征(FRNS)15例。另取20例健康体检儿童作为正常对照组。分别在三个时间点采集外周血标本及尿标本：第1时间点,发病初期未用糖皮质激素(GC)时；第2时间点,足量GC治疗8周时；第3时间点,GC治疗16周或病情反复时。进行如下实验①ELISA法检测患儿不同时间点尿液中MCP-1及IL-18的水平②采用全自动生化分析仪测定PNS患儿不同时间点血尿素氮、肌酐及24小时尿蛋白定量。结果： 1. SSNS组治疗前、治疗后8周尿MCP-1水平均高于正常对照组,差异无显著性(P0.05)；但治疗16周后显著低于治疗前、治疗后8周及正常对照组(P0.05)。SRNS组治疗前尿MCP-1水平显著高于SSNS组治疗前与对照组(P0.05),但与治疗后8周比较无显著差异(P0.05),当联合免疫抑制剂环磷酰胺治疗16周后则显著低于治疗前、治疗后8周(P0.05)。分别对三个时间点SRNS组和SSNS组患儿尿MCP-1的水平进行比较,SRNS组均显著高于SSNS组(P均0.05)。 2. FRNS组患儿治疗前、治疗后8周尿MCP-1水平与正常对照组,及SSNS组比较无显著差异(P0.05),但显著低于SRNS组(P0.05),当病情反复时,与治疗前、治疗后8周及对照组比较尿MCP-1水平显著增高,差异有显著性(P0.05),且显著高于SSNS组治疗后8周(P0.05),与SRNS组治疗后8周比较无显著差异(P0.05)。 3. SSNS组治疗前、治疗后8周尿IL-18水平均高于正常对照组,差异有显著性(P0.05)；治疗16周后显著低于治疗前、治疗后8周(P0.05)。SRNS组治疗前显著高于SSNS组治疗前与对照组(P0.05),但与治疗后8周比较无显著差异(P0.05),当联合免疫抑制剂环磷酰胺治疗16周后则显著低于治疗前、治疗后8周(P0.05)。分别对三个时间点SRNS组和SSNS组患儿尿IL-18的水平进行比较,SRNS均显著高于SSNS组(P0.05)。 4. FRNS组患儿治疗前、治疗后8周尿IL-18水平显著高于正常对照组(P0.05),与SSNS组比较无显著差异(P0.05)；但显著低于SRNS组(P0.05)。当病情反复时,与治疗前、治疗后8周及对照组比较尿IL-18水平显著增高(P均0.05),且显著高于SSNS组治疗8后周(P0.05),与SRNS组治疗后8周比较无显著差异(P0.05)。 5.尿MCP-1及IL-18与血尿素氮、肌酐之间无相关性,与24小时尿蛋白定量呈显著正相关。另外尿MCP-1水平与尿IL-18水平有相关性。结论： 1.PNS患儿尿MCP-1及IL-18水平均升高,尤其在SRNS组显著高于SSNS组,提示在糖皮质激素治疗初期检测尿MCP-1及IL-18有助于早期预测患儿对糖皮质激素的敏感性,从而为临床医师制定合理治疗方案提供实验室依据。 2.MCP-1及IL-18在尿液中的水平升高可以判断PNS疾病活动性,为临床医师提早启动更为合理的治疗方案提供理论依据。 3.尿MCP-1及IL-18水平增高,结合PNS患儿的临床症状及蛋白尿等指标可作为监测肾病反复的无创的重要指标。
[Abstract]:Purpose :

The levels of monocyte chemoattractant protein - 1 ( MCP - 1 ) and interleukin - 18 ( IL - 18 ) in urine of children with primary nephrotic syndrome ( PNS ) were examined .

Method :

In this study , 65 PNS children hospitalized in our hospital were selected as the subjects . The results were divided into three groups : hormone - sensitive nephrotic syndrome ( SSNS ) , 35 cases of hormone - resistant nephrotic syndrome ( SRNS ) , 15 cases of recurrent nephrotic syndrome ( FRNS ) .
At the second point of time , a sufficient amount of GC was used for 8 weeks ;
The levels of MCP - 1 and IL - 18 in urine of children with PNS were measured by ELISA . The levels of MCP - 1 and IL - 18 in urine were measured by ELISA . Blood urea nitrogen , creatinine and 24 - hour urinary protein were measured at different time points in children with PNS .

Results :

1 . Before treatment , the level of MCP - 1 in urine was higher than that of control group before and after treatment ( P0.05 ) .
The levels of MCP - 1 in the SRNS group were significantly higher than those in the control group ( P0.05 ) before and 8 weeks after treatment ( P0.05 ) . The levels of urinary MCP - 1 were significantly lower in SRNS group than in SSNS group ( P < 0.05 ) .

2 . There was no significant difference between the levels of MCP - 1 and the SSNS group ( P0.05 ) before and after treatment in the FRNS group , but significantly lower than that in SRNS group ( P0.05 ) .

3 . Before treatment , the levels of urinary IL - 18 were higher in 8 weeks after treatment than those in the normal control group ( P0.05 ) .
The levels of urinary IL - 18 in SRNS group and SSNS group were significantly lower than those in control group before and 8 weeks after treatment ( P0.05 ) . The levels of urinary IL - 18 were significantly higher in SRNS group and SSNS group than in SSNS group ( P0.05 ) .

4 . The levels of urinary IL - 18 before and after treatment in FRNS group were significantly higher than those in the normal control group ( P0.05 ) , but there was no significant difference compared with the SSNS group ( P0.05 ) .
Compared with SRNS group ( P0.05 ) , the levels of urinary IL - 18 were significantly higher than that in SRNS group ( P < 0.05 ) , and significantly higher than that in SSNS group after 8 weeks ( P0.05 ) . There was no significant difference between the 8 weeks after treatment with SRNS group ( P0.05 ) .

5 . There was no correlation between urinary MCP - 1 and IL - 18 and blood urea nitrogen and creatinine .

Conclusion :

1 . The levels of urinary MCP - 1 and IL - 18 in children with PNS increased , especially in SRNS group than in SSNS group , suggesting that MCP - 1 and IL - 18 could be used to predict the sensitivity of children to glucocorticoid in the early stage of glucocorticoid therapy , thus providing laboratory basis for clinicians to develop rational treatment plan .

2 . The level of MCP - 1 and IL - 18 in urine can judge the activity of PNS and provide theoretical basis for the clinician to start a more reasonable treatment plan early .

3 . The levels of urinary MCP - 1 and IL - 18 were increased , and the clinical symptoms and proteinuria indexes of the children with PNS could be used as an important index for the monitoring of recurrent renal disease .
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.9

【参考文献】