探讨自动测定多项血液指标对原发性肾病综合症的诊断价值

To explore the diagnostic value of automatic determination of multiple blood indexes in primary nephrotic syndrome

目的:探讨血清免疫球蛋白(Ig)、脂蛋白a[Lp(a)]和视黄醇结合蛋白(RBP)的表达水平在原发性肾病综合征(PNS)临床辅助诊断中的应用价值。方法:选取本院儿科2019年1月~2019年12月收治确诊住院的84例PNS患儿[包括43例单纯型PNS患儿(单纯型组)和41例肾炎型PNS患儿(肾炎型组)],以及同期在本院作儿童保健的45例健康儿童(对照组)作为研究对象。根据PNS肾小管间质病变严重程度,分为Ⅰ组(25例)、Ⅱ组(22例)、Ⅲ组(19例)和Ⅳ组(17例),检测各组血清免疫球蛋白M(IgM)、免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、Lp(a)、RBP和血清肌酐(SCr)等指标。结果:单纯型组血清IgM、Lp(a)和RBP表达水平高于对照组,IgG表达水平低于对照组,组间比较差异有统计学意义(P>0.05)。IgA和SCr表达水平高于对照组,组间比较差异无统计学意义(P>0.05)。肾炎型组血清IgM、Lp(a)和RBP表达水平高于单纯型组和对照组,IgG表达水平低于单纯型组和对照组,组间比较差异有统计学意义(P<0.05),IgA和SCr表达水平高于单纯型组和对照组,组间比较差异无统计学意义(P>0.05)。在肾小管间质病理损害程度各组中,血清IgM、Lp(a)和RBP表达水平随PNS患儿肾小管间质病理损害程度加重呈明显升高趋势(P<0.05),血清IgG则呈明显下降趋势(P<0.05)。血清IgA表达水平呈升高趋势(P>0.05)。血清SCr仅在肾小管间质病变范围达Ⅲ组和Ⅳ组时,其表达水平才有明显升高趋势(P<0.05)。结论:血清Ig、Lp(a)和RBP的表达水平与PNS的发生与发展密切相关,临床应加强对PNS患儿血清Ig、Lp(a)和RBP指标的监测,其表达水平改变有助于临床医生对PNS的临床分型和肾小管间质病理损害程度的判断。

objective:To investigate the value of serum immunoglobulin(Ig),lipoprotein a[Lp(a)]and retinol binding protein(RBP)expression levels in clinical auxiliary diagnosis of primary nephrotic syndrome.Methods:Select 84 PNS children admitted to hospital in January 2019~December 2019[including 43 simple PNS children(simple group)and 41 nephritis PNS children(nephritis group)],And 45 healthy children(control group)in our hospital were studied.According to the severity of renal tubulointerstitial lesions in PNS children,group I(25 cases),group II(22 cases),group III(19 cases)and group IV(17 cases),Testing groups Serum immunoglobulin M(IgM),immunoglobulin G(IgG),immunoglobulin A(IgA),Lp(a),RBP and serum creatinine(SCr)were cleared.Results:Serum IgM、Lp(a)and RBP expression levels in the simple group were higher than those in the control group,IgG expression levels were lower,the difference between groups was statistically significant(P<0.05),IgA and SCr expression levels were higher,There was no statistical difference between groups(P>0.05).Serum IgM、Lp(a)and RBP expression levels in the nephritis group were higher than those in the simple group and the control group,IgG expression levels were lower than those in the control group,the difference between groups was statistically significant(P<0.05),The expression levels of IgA and SCr were higher than those of control group,the difference between groups was statistically significant(P>0.05).In each group with the degree of pathological damage in tubulointerstitial,Serum IgM、Lp(a)and RBP expression levels increased significantly with the increase of renal tubulointerstitial pathological damage in PNS children(P<0.05),Serum IgG showed a significant downward trend(P<0.05).The level of serum IgA expression increased(P>0.05).Serum SCr increased only when the range of renal tubulointerstitial lesions reached group III and group IV(P<0.05).Conclusion:TThe expression levels of serum Ig、Lp(a)and RBP are closely related to the occurrence and development of PNS,Clinically,the monitoring of serum Ig,Lp(a)and RBP indicators in children with PNS should be strengthened,and changes in expression levels can help clinicians to judge the extent of pathological damage to PNS's clinical division and renal tube intersophysiology.