肾病综合征患儿尿总、结合及游离皮质醇水平的测定和意义

Determination of urinary total ?bound and unbound cortisol level and its clinical significance in children with idiopathic nephrotic syndrome

分子筛法分离尿中结合及游离皮质醇,放射免疫法测定18例特发性肾病综合征(INS)患儿血清皮质醇和尿总、结合及游离皮质醇含量。结果:病例组8Am血皮质醇浓度显著低于对照组(264.88nmol/L比618.51nmol/L,P<0.01);24小时尿总、结合皮质醇定量显著高于对照组(分别为256.37±86.74nmol/24hr比71.73±3.08nmol/24hr及181.89±84.12nmol/24hr比1.80±0.53nmol/24hr,P均<0.01);两组儿童尿游离皮质醇含量无显著差异。本文结果揭示肾病综合征患儿血皮质醇降低的原因与大量皮质醇结合蛋白自尿中排出有关,患儿肾上腺皮质分泌功能正常。

The urinary bound and unbound cortisols were isolated by molecular sieve?and the serum cortisol and urinary total, bound and unbound cortisol levels were determined by radioimmunoassay in 18 children with idiopathic nephrotic syndrome (INS) and 15 normal children, respectively. The results showed that the serum cortisol level (8 Am) in INS group was significantly lower than that in the control group(264. 88 nmol/L vs. 618. 51 nmol/L,.P<0. 01) .while the urinary total cortisol and bound cortisol levels within 24 hours in the INS group were obviously higher than those in the control group, respectively (256. 37 ±86. 74 nmol/24hr vs. 71. 73 ± 3. 08nmol/24hr, P<0. 01 ; 181. 89 ±84. 12 nmol/24hr vs. 1. 80 ± 0. 53 nmol/24hr,,P<0. 01). No significant difference of urinary unbound corticol level was found between two groups. It is suggested that the reason of lower serum cortisol level in the INS patients will be probably correlated to the excessive excretion of cortisol binding protein from urine. It is confirmed that the adrenal cortex function is normal basically in the INS patients.