慢性肾小球肾炎患者尿液TNFR1检测的临床意义

The potential value of determination for urinary soluble tumor necrosis factor receptor 1 excretion in patients with primary chronic glomerulonephritis

目的探讨慢性肾小球肾炎患者尿液肿瘤坏死因子a特异性的膜受体1（TNFR1）在评价。肾脏损伤程度中的价值以及对。肾功能损害的预测价值。方法选择在我院经病理检查确诊的原发性慢性肾小球肾炎患者50例，另选择20名健康体检者为对照组。检测2组24h尿蛋白定量，血清和尿液的肌酐浓度，计算肌酐清除率。酶联免疫法（ELISA）检测尿液TNFR1浓度。所有研究对象随访2年，每6个月1次，随访时检测肾功能。结果不同病理类型的慢性。肾小球肾炎患者尿液TN—FR1浓度均较对照组升高（P〈0．05）；病情恶化者肌酐清除率低于病情稳定患者（P〈0．05），尿液TNFRI浓度高于病情稳定者（P〈0．05），2组24h尿蛋白定量无明显差异（P〉O．05）；尿液TNFRl浓度与肌酐清除率呈负相关（P〈0．05），与24h尿蛋白定量呈正相关（P〈0．05）；年龄、24h尿蛋白定量和尿液TNFR1浓度是基线肌酐清除率的影响因素（P〈0．05）；尿液TNFRl浓度是病情恶化者肌酐清除率下降的独立影响因素（P〈0．05）。结论尿液TNFRl浓度可以评价和预测慢性肾小球肾炎患者肾功能损害。

Objective To explore the potential value and predicted value of determination for urinary soluble tumor necrosis factor receptor 1 （TNFR1） excretion in evaluating progressive renal function deterioration in patients with primary chronic glomerulonephritis. Methods Fifty patients with primary chronic glomerulonephritis and 20 healthy subjects were included in the study. TNFR1 was determined by using ELISA. Twenty-four-h urine protein was quantitatively measured. Serum and urine creatinine concentrations were measured by using the standard procedure, and creatinine clearance was calculated. Results Urinary excretion of TNFR1 in the patients with chronic glomerulo- nephritis was greater than in the healthy subjects （P〈0. 05）. There was a significant negative correlation between TNFR1 excretion and creatinine clearance, and a positive correlation between TNFR1 excretion and 24-h urine protein （P〈0. 05）. Urinary excretion of TNFR1 predicted progression of renal function impairment （P〈0. 05）. The patients were followed up for two years, once every 6 months. Conclusions Markedly elevated urinary TNFR1 excretion may be considered as a good marker of an activated TNFα-pathway in patients with primary chronic glomerulonephritis, and as a potentially modifiable risk factor of progressive kidney function impairment.