尿急性肾损伤标志物与抗中性粒细胞胞浆抗体相关性肾炎预后相关性研究

发布时间：2018-02-24 17:19

本文关键词： 抗中性粒细胞胞浆抗体相关性肾炎尿中性粒细胞明胶酶相关脂质运载蛋白肾脏损伤分子-　出处：《中国实用内科杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的分析尿中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)及肾脏损伤分子-1(kidney injury molecule-1,KIM-1)与抗中性粒细胞胞浆抗体(anti-neutrophil cytoplasmic antibody,ANCA)相关性肾炎(ANCA associated glomerulonephritis,AAGN)严重程度及预后的关系。方法回顾2009年4月至2013年11月间南京军区南京总医院肾脏科住院的69例AAGN患者,其中抗过氧化物酶抗体阳性61例,抗蛋白酶3抗体阳性8例,肾活检进行病理分型及肾小管间质炎症细胞浸润和肾间质纤维化及肾小管萎缩半定量积分。尿NGAL及KIM-1采用ELISA方法检测,Spearman检验分析尿NGAL及KIM-1与肾脏损害指标(血肌酐、尿蛋白及血白蛋白)的关系,采用Mann-Whitney检验比较组间差异,分析尿NGAL及KIM-1与肾小管病变评分及肾脏预后的关系。结果69例AAV肾脏病理类型:局灶型14例,新月体型26例,混合型29例。基线肌酐:276.69(47.74~1193.40)μmol/L,24 h尿蛋白定量1.61(0.11~9.78)g。3种病理类型之间尿NGAL及KIM-1差异无统计学意义。尿NGAL与尿蛋白及Scr呈正相关(r值分别为0.3242、0.3257,P分别为0.0095、0.0081),与血清白蛋白呈负相关(r=-0.3964,P=0.0009)。尿KIM-1与血清白蛋白呈负相关(r=-0.2539,P=0.0413),但与血肌酐及尿蛋白无相关性。尿KIM-1与肾间质浸润细胞程度相关,差异有统计学意义(P=0.0413)。尿NGAL与肾间质浸润细胞程度无相关性。45例随访24(14~58)个月,13例进入终末期肾脏疾病者基线尿NGAL高于未进入终末期肾脏疾病者[(117.6(3.06~518.4)μg/L对28.86(2.17~461.5)μg/L,P=0.0372)],多因素COX回归分析示尿NGAL为不良肾脏预后的独立危险因素(HR 1.012,95%CI 1.001~1.022,P=0.033)。结论尿NGAL水平反映AAGN的严重程度,为不良肾脏预后的独立危险因素,而KIM-1与间质浸润细胞程度相关。
[Abstract]:Analysis of urinary neutrophil gelatinase associated lipocalin (neutrophil gelatinase-associated lipocalin, to NGAL) and -1 (kidney injury kidney injury molecule molecule-1, KIM-1) and anti neutrophil cytoplasmic antibody (anti-neutrophil cytoplasmic antibody ANCA (ANCA associated glomerulonephritis) gn, AAGN) the relationship between the severity and prognosis. Methods: April 2009 to November 2013, Nanjing general Hospital of Nanjing military hospital kidney in 69 AAGN patients, including anti peroxidase antibody positive in 61 cases, 3 anti protease antibody positive in 8 cases, renal biopsy pathology and renal tubular interstitial inflammatory cell infiltration and renal interstitial fibrosis and tubular atrophy. Semi quantitative urine NGAL and KIM-1 detected by ELISA, NGAL and KIM-1 Spearman analysis of urine and kidney damage indexes (serum creatinine, urine protein and blood white eggs White) relationship, were analyzed by Mann-Whitney test, analysis of the relationship between urinary NGAL and KIM-1 with renal tubular lesion score and renal prognosis. Results 69 cases of AAV type of renal pathology in focal crescentic type in 14 cases, 26 cases, 29 cases of mixed type. Baseline creatinine: 276.69 (47.74~ 1193.40) mol/L. 24 h urinary protein 1.61 (0.11~9.78) there was no significant difference between G.3 KIM-1 and urinary NGAL pathological types. The urinary NGAL was positively correlated with urinary protein and Scr (r = 0.3242,0.3257, P = 0.0095,0.0081), and negatively correlated with serum albumin (r=, -0.3964, P=0.0009). The urinary KIM-1 was negatively correlated with serum albumin (r=-0.2539, P=0.0413), but no correlation with serum creatinine and urine protein. KIM-1 in urine and renal interstitial cell infiltration degree, the difference was statistically significant (P=0.0413). The NGAL in urine and renal interstitial cell infiltration degree had no correlation between.45 cases were followed up for 24 months, 13 (14~58) Cases of end-stage renal disease at baseline urinary NGAL was higher than that of end-stage renal disease ([117.6 (3.06~518.4) g/L 28.86 (2.17~461.5) g/L, P=0.0372), COX regression analysis showed the independent risk factors for poor prognosis of kidney and urinary NGAL (HR 1.012,95%CI 1.001~1.022, P=0.033). Conclusion urine NGAL level can reflect the severity of AAGN, independent risk factors and adverse renal outcome, KIM-1 and interstitial infiltrating cells is related to the degree.

【作者单位】：南京军区南京总医院国家肾脏疾病临床医学研究中心;
【基金】：国家科技支撑课题(2013BAI09B04,2015BAI12B05)
【分类号】：R692.3

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