原发性肾病综合征患儿血清CD_(146)水平及其意义

Serum Levels of CD_(146) and Its Significance in Children with Primary Nephrotic Syndrome

目的探讨血清CD146在原发性肾病综合征(PNS)患儿中的水平及其临床意义。方法选取2010年3月-2011年3月在本院肾内科住院的初发PNS患儿33例,根据对激素治疗反应不同将其分为激素敏感型肾病综合征(SSNS)组(28例)和激素耐药型肾病综合征(SRNS)组(5例)。取年龄、性别相匹配的健康儿童18例作为健康对照组。利用ELISA检测血清CD146水平,比较血清CD146在3组间及SSNS组泼尼松治疗前后不同,同时分析血清CD146与各临床指标的关系。结果 1.SSNS组、SRNS组患儿血清CD146水平均高于健康对照组(Pa<0.05),SRNS组血清CD146水平高于PNS患儿SSNS组,但差异无统计学意义(P>0.05)。2.SSNS组泼尼松治疗后血清CD146水平下降,差异有统计学意义(P<0.05)。3.血清CD146水平与血清胆固醇、24 h尿蛋白定量、血浆纤维蛋白原、尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)均呈正相关(Pa<0.05),与血清清蛋白、肌酐、胱蛋白酶抑制剂C、β2-微球蛋白、血浆凝血酶原时间、活化部分凝血活酶时间、血浆凝血酶时间均无相关性(Pa>0.05)。结论 PNS患儿存在内皮功能和凝血功能紊乱,血清CD146有望成为评价PNS患儿体内高凝状态的指标,CD146可能参与了PNS细胞免疫方面的发病机制,而糖皮质激素治疗可抑制免疫炎性反应、减轻血管内皮损伤。

Objective To examine the level of serum adhesion molecule CD146 in children with primary nephrotic syndrome（PNS） and explore its clinical significance. Methods Thirty-three children with PNS who were admitted into Children′s Hospital of Tianjin from Mar.2010 to Mar.2011 were investigated.According to therapeutic effect of glucocorticosteroid,28 children were divided into steroid-sensitive nephrotic syndrome（SSNS） group and 5 children into steroid-resistant nephrotic syndrome（SRNS） group,meanwhile,18 age/sex-matched healthy children were chosen as healthy control group.Enzyme-linked immunosorbent assay was used to examine the level of serum CD146 in all the children.The differences of serum CD146 in 3 groups as well as the differences before and after treatment of prednisone in SSNS group were compared.Meanwhile,the relationship of serum adhesion molecule CD146 with other clinical parameter was analyzed. Results 1.The level of serum CD146 in group SSNS and group SRNS were higher than that in healthy control group（Pa0.05）,and the level of serum CD146 in group SRNS was higher than that in group SSNS,but the difference was not statistically significant（P0.05）.2.The level of serum CD146 showed decrease in group SSNS after treatment of prednisone and the difference was statistically significant（P0.05）.3.In experiment groups,the level of serum CD146 showed positive correlation with serum cholesterol,urinary protein of 24 hours,plasma fibrinogen,urine N-acetyl-β-D-glucosaminidase（NAG） enzyme（Pa0.05） and had no linear correlation between serum-albumin,serum creatinine,cystatin C,β2-microglobulin,prothrombin time,activated partial thromboplastic time,and thrombin time（Pa0.05）. Conclusions There are coagulopathy and endothelium functional disorder in children with PNS,and CD146 may serve as the index to evaluate hypercoagulable state in children of PNS.Adhesion molecule CD146 may participate in the pathogenesis of PNS cell immunity.Treatment of glucocorticosteroid can immunosuppress inflammatory reaction and relieve blood vessel endothelium hazard.