中性粒细胞明胶酶相关脂质运载蛋白与狼疮性肾炎活动性及病理分型关系的初步研究

发布时间：2018-06-28 02:39

  本文选题：中性粒细胞明胶酶相关脂质运载蛋白 + 狼疮性肾炎　； 参考：《中南大学》2014年硕士论文

【摘要】：目的 分析中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在系统性红斑狼疮(SLE)肾脏病变中的意义,探讨血清及尿液NGAL (pNGAL及uNGAL)水平与狼疮性肾炎(LN)活动性及病理分型之间的关系。 方法 1.收集104例SLE患者(包括63例LN患者及41例非肾炎SLE患者)及60例对照者(包括非SLE的其他自身免疫性疾病和正常对照者各30例)的血液、尿液标本,用胶乳增强免疫比浊法分别测定pNGAL和iNGAL的表达水平。 2.根据肾脏SLEDAI评分,将LN患者分为活动期LN (n=41)和静止期LN (n=22),测定pNGAL和uNGAL的表达水平。同时收集LN患者的临床及实验室资料。据测得的uNGAL建立ROC曲线,分析uNGAL对诊断LN活动性的敏感性和特异性。 3.将LN患者按肾活检的结果分为不同病理类型的LN,比较不同病理类型LN的pNGAL和uNGAL表达水平的差异。 结果 1.SLE患者的pNGAL与uNGAL水平都高于对照组(P0.01)；与非肾炎SLE患者相比,LN患者的pNGAL与uNGAL水平均显著升高,差异有统计学意义(P0.05,P0.01)； 2.活动期LN患者与静止期LN患者相比,pNGAL水平无明显差异(216.05±133.67ng/mL vs172.75±91.68ng/mL;而uNGAL在活动期LN患者尿液中的水平明显高于静止期LN患者(0.76±0.40ng/mg Cr vs0.45±0.29ng/mg Cr, P0.01); 3.LN患者的pNGAL水平与SLEDAI评分之间均无明显的相关性；uNGAL水平与肾脏SLEDAI评分(r=0.364,P0.01)之间呈正相关,评分值越高,uNGAL的结果就越大； 4. uNGAL的ROC曲线截值点为0.585ng/mg Cr,此时的敏感性和特异性分别为70.73%和77.27%(P0.01)。ROC曲线下面积为0.756； 5.不同病理分型LN患者间的pNGAL水平无明显差异(P0.05)；Ⅲ型和Ⅳ型LN患者的uNGAL水平虽较其他组高,但差异无统计学意义(P0.05)；增殖型和膜型LN患者之间的pNGAL、 uNGAL水平均无明显差异(P0.05)。 结论 1.SLE患者发生肾脏病变时,其pNGAL、uNGAL的浓度都会增高； 2. pNGAL不能作为判断LN活动性的标志物,uNGAL有可能成为一种新的反映LN活动性的可靠标志物； 3.不同病理分型LN患者的pNGAL、uNGAL水平无差别,两者均不能作为增殖型LN的标志物。
[Abstract]:Objective to investigate the significance of neutrophil gelatinase-associated lipid carrier protein (NGAL) in renal lesions of systemic lupus erythematosus (SLE). To investigate the relationship between serum and urine NGAL (pNGAL and uNGAL), lupus nephritis (LN) activity and pathological classification. Method 1. Blood and urine samples were collected from 104 SLE patients (including 63 LN patients and 41 non-glomerulonephritis SLE patients) and 60 controls (including 30 non-SLE patients with other autoimmune diseases and 30 normal controls). The expression levels of pNGAL and iNGAL were determined by latex enhanced immunoturbidimetry. 2. According to the SLEDAI score of kidney, the patients with LN were divided into active LN (nong41) and resting LN (nong22). The expression of pNGAL and uNGAL were measured. The clinical and laboratory data of LN patients were also collected. The ROC curve was established to analyze the sensitivity and specificity of uNGAL in the diagnosis of LN activity. According to the results of renal biopsy, LN patients were divided into different types of LNs, and the expression levels of pNGAL and uNGAL in LN were compared. Results 1. The levels of pNGAL and uNGAL in SLE patients were higher than those in control group (P0.01), and the levels of pNGAL and uNGAL in LN patients were significantly higher than those in non-glomerulonephritis SLE patients (P0.05, P0.01). There was no significant difference between active LN patients and rest LN patients (216.05 卤133.67ng / mL vs172.75 卤91.68ng / mL), but the level of uNGAL in the urine of active LN patients was significantly higher than that of rest LN patients (0.76 卤0.40ng/mg Cr vs0.45 卤0.29ng/mg Cr0.01). 3. The level of pNGAL in LN patients and SLEDAI score was higher than that in inactive LN patients (P0.01). There was no significant correlation between them. There was a positive correlation between the level of uNGAL and the SLEDAI score of kidney (r = 0.364, P 0.01), and the higher the score was, the greater the result of uNGAL was. 4. The cut point of ROC curve of uNGAL was 0.585ng/mg Cr.The sensitivity and specificity of the curve were 70.73% and 77.27% (P0.01) .ROC curve area was 0.756; 5. There was no significant difference in the level of pNGAL between LN patients with different pathological types (P0.05); the level of uNGAL in type 鈪，

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