血清LRG1、NGAL和PGC-1α水平与小儿肾积水手术后分肾功能的相关性研究

Correlation between serum leucine rich alpha-2-glycoprotein 1,neutrophil gelatinase associated apolipoprotein,peroxisome proliferator activated receptor γ coactivator factor-1α and postoperative renal function in children with hydronephrosis

目的探究血清富亮氨酸α2-糖蛋白1(leucine-richα2 glycoprotein 1,LRG1)、中性粒细胞明胶酶相关载脂蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、过氧化物酶体增殖物激活受体γ辅助激活因子-1α(peroxisome proliferator activated receptorγcoactivator-1α,PGC-1α)水平与小儿肾积水术后分肾功能(differential renal function,DRF)的相关性。方法本研究为回顾性研究,选取邯郸市中心医院2019年3月至2022年6月期间行肾盂输尿管成形术的124例肾积水患儿作为研究对象,根据术后18个月DRF情况,将患儿分为DRF≥45%组(n=72)和DRF<45%组(n=52)。采用酶联免疫吸附法检测患儿血清中LRG1、NGAL和PGC-1α水平。采用Pearson相关性分析探讨血清LRG1、NGAL、PGC-1α水平与肾功能的相关性,采用二元Logistic回归分析肾积水患儿术后DRF<45%的影响因素,通过受试者工作特征(receiver operating characteristic,ROC)曲线分析血清LRG1、NGAL、PGC-1α对肾积水患儿术后DRF的预测价值。结果DRF≥45%组和DRF<45%组患儿血清LRG1分别为(184.28±55.46)ng/mL、(315.62±98.53)ng/mL(t=9.437,P<0.05);肌酐(rerum Creatinine,Scr)分别为(26.84±7.64)μmol/L和(35.46±10.27)μmol/L(t=5.361,P<0.05);尿素氮(blood urea nitrogen,BUN)分别为(5.24±1.52)mmol/L和(7.23±2.31)mmol/L(t=5.783,P<0.05);β_(2)-微球蛋白(β_(2)-microglobulin,β_(2)-MG)分别为(2.16±0.43)mg/L和(3.68±0.84)mg/L(t=13.164,P<0.05);PGC-1α分别为(4.26±1.14)ng/mL和(2.85±0.89)ng/mL(t=7.430,P<0.05);术前患侧DRF分别为(43.25±4.57)%和(31.58±3.68)%(t=15.192,P<0.05);差异均有统计学意义。Pearson相关性分析结果显示,LRG1、NGAL与Scr、BUN、β_(2)-MG呈正相关(P<0.05);PGC-1α与β_(2)-MG、Scr、BUN呈负相关(P<0.05)。Logistic回归分析显示,血清LRG1、NGAL、Scr、BUN、β_(2)-MG、PGC-1α、术前患侧DRF是术后DRF<45%的影响因素(P<0.05)。ROC曲线分析显示,血清LRG1、NGAL、PGC-1α及三者联合评估肾积水患儿术后DRF<45%的曲线下面积(area under the curve,AUC)分别为0.899、0.872、0.878及0.982,三者联合评估优于单独评估(Z_(三者联合-LRG1)=3.148、Z_(三者联合-NGAL)=3.937、Z_(三者联合-PGC-1α)=3.125,P<0.05)。结论肾积水术后DRF<45%的患儿血清中LRG1、NGAL水平升高,PGC-1α水平降低,三者联合检测对于术后DRF具有一定的预测价值。

Objective To explore the correlation between serum levels of leucine rich alpha-2-glycoprotein 1(LRG1),neutrophil gelatinase associated apolipoprotein(NGAL),peroxisome proliferator activated receptorγcoactivator factor-1α(PGC-1α)and postoperative differential renal function(DRF)in children with hydronephrosis.Methods From March 2019 to June 2022,124 children with hydronephrosis undergoing pyeloureteroplasty were selected as study subjects.Based upon postoperative DRF at Month 18,they were assigned into two groups of DRF≥45%(n=72)and DRF<45%(n=52).Enzyme-linked immunosorbent assay(ELISA)was applied for detecting the serum levels of LRG1,NGAL and PGC-1α.Pearson's correlation was utilized for examining the correlation between serum levels of LRG1,NGAL,PGC-1αand renal function.Multivariate Logistic regression was employed for analyzing the factors affecting postoperative DRF<45%.Receiver operating characteristic(ROC)curve was used for evaluateing the serum values of LRG1,NGAL and PGC-1αin postoperative DRF in children with hydronephrosis.Results As compared with DRF≥45%group,DRF<45%group had higher levels of serum LRG1,NGAL,serum creatinine(Scr),blood urea nitrogen(BUN),andβ_(2)-microglobulin(β_(2)-MG)and lower levels of PGC-1αand preoperative DRF at affected side(P<0.05).According to Pearson's correlation analysis,LRG1 and NGAL were correlated positively with Scr,BUN andβ_(2)-MG(P<0.05).And PGC-1αwas correlated negatively withβ_(2)-MG,Scr and BUN(P<0.05).Multivariate Logistic regression analysis indicated that serum LRG1,NGAL,preoperative DRF at affected side,Scr,BUN andβ_(2)-MG were risk factors affecting postoperative DRF<45%while PGC-1αwas a protective factor affecting postoperative DRF<45%(P<0.05).According to ROC curve analysis,area under the curve(AUC)of serum LRG1,NGAL,PGC-1αand their combined evaluation for postoperative DRF<45%was 0.899,0.872,0.878 and 0.982 respectively.And the combination of three factors was superior to each alone(Z three combined evaluation-LRG1=3.148,Z three combined evaluation-NGAL=3.937,Z three combined evaluation-PGC-1α=3.125,P<0.05).Conclusions There are the elevations of serum levels of LRG1 and NGAL and a decline of PGC-1αin hydronephrosis children with postoperative DRF<45%.The combined detection of the three has some evaluation values for postoperative DRF.