肾病综合征尿蛋白类型、小管间质损害及激素疗效的关系

Relationship between the types of urinary protein .tubulointerstitial insult and therapeutical effect of steroids in children with nephrotic syndrome

为了探讨肾病综合征(NS)患儿蛋白尿类型、小管间质损害及激素疗效的关系,检测68例NS患儿尿蛋白类型,测定30例健康儿童及患儿24h尿α_1-微球蛋白(α_1-MG)、β_2-微球蛋白(β_2-MG)及Tamm-Horsfall蛋白(THP)。结果27例非选择性蛋白尿者(NSPU组)尿α_1-MG、β_2-MG显著高于41例选择性蛋白尿者(SPU组)及健康儿童,而尿THP显著低于SPU组及健康儿童(P<0.01)。激素治疗8周后,NSPU组未缓解者(66.7％)显著多于SPU组7.3％,(P<0.01)。本文表明NSPU患儿存在着明显的肾小管间质损害,其激素疗效差,提示其预后不良。

To explore the relationship between the types of urinary protein, tubulointerstitial insult and therapeutical effect of steroids in children with primary nephrotic syndrome (PNS), urinary protein analysis had been determined in 68 NS children and 30 normal control children by the way of SDS -PAGE. The levels of α1 -microglobulin(α1 -MG) .β2 -microglob-ulin(β2 -MG)and Tamm -Horsfall protein (THP) in 24 -hours urine were simultaneously assessed by RIA way in same two groups. The results showed that the levels of α1 - MG and β2 - MG were much higher and urinary THP level was much lower in 27 cases with non - selective proteinuria(NSPU)than those in 41 cases with selective proteinuria(SPU)and in 30 normal control children, respectively (P all<0. 01). It was noticed that the number of steroid - resistant cases increased obviously in NSPU children comparing to that in SPU children after being treated with prednisone for 8 months (66. 7% vs. 7.3%, F< 0. 01). The present study demonstrated that there might be serious tubulointerstitial insult, rather poorer therapeutical effect of steroids and worse prognosis in NS patients with NSPU.