尿sCD_(146)与慢性肾脏病的关系及其临床意义的探讨

Relationship and Clinical Significance Between Soluble CD_(146) in the Urine and Chronic Kidney Disease

目的:探讨尿sCD146水平在慢性肾脏病(CKD)中的意义及其与肾功能相关指标的关系。方法:入选105例CKD患者,CKD1期28例,CKD2期27例,CKD3期16例,CKD4期14例,CKD5期20例,(非透析患者)。设健康对照组20例。采用ELISA法检测尿sCD146水平。分析尿sCD146在CKD各期中的变化及其与肾功能相关指标的关系。结果:CKD1～5期患者尿sCD146水平均较对照组升高。各组CKD患者尿sCD146水平[CKD1(139.53±7.69)ng/ml,CKD2(156.02±15.37)ng/ml,CKD3(174.87±2.55)ng/ml,CKD4(190.66±8.01)ng/ml,CKD5(211.76±22.99)ng/ml],均显著高于对照组(128.09±4.05)ng/ml。尿sCD146水平随着CKD1～5期进展升高,P<0.05。CKD3～5期患者超敏C-反应蛋白(hs-CRP)较对照组升高、且随着CKD的进展进行性升高(P<0.05)。相关分析显示尿sCD146与血sCD146、Scr、BUN、β2-MG、CysC、hs-CRP水平呈正相关(r分别为:0.697,0.699,0.871,0.755,0.524、0.414),与eGFR、Hb、Alb呈负相关(r分别为:-0.787,-0.601,-0.298)。结论:尿sCD146与肾功能水平密切相关,可能反映早期肾功能的损伤及严重程度,并与CKD患者机体的炎症状态相关。外周血、尿液中有sCD146的异常表达,可能参与了肾脏损伤的免疫机制,能否作为检测CKD患者早期肾功能损伤新的敏感性标志物,仍需要更多样本的临床研究证实。

Objective：To detect the level of soluble CDl46（sCD146） in the urine and explore its relationship with chronic kidney disease（CKD）.Methods：A total of 105 patients with CKD,including 28 cases of CKD1,27 cases of CKD2,16 cases of CKD3,14 cases of CKD4,20 cases of CKD5（none case of dialysis）.20 healthy volunteers were enrolled as control.levels of sCD146 in the urine were measured by ELISA.Results：The levels of urine sCD146 in patients from CKD1 to CKD5 group are significantly higher than those in control group.The levels of sCD146 in each CKD group are [CKD1（139.53 ± 7.69） ng/ml,CKD2（156.02 ± 15.37） ng/ml,CKD3（174.87 ± 2.55） ng/ml,CKD4（190.66 ± 8.01） ng/ml,CKD5（211.76 ± 22.99） ng/ml],which were significantly higher than those in control group（128.09 ± 4.05） ng/ml.sCD146 levels in the urine were gradually increased according to the different stages of CKD（P 〈 0.05）,The levels of hypersensitive CRP in patients with CKD3 to CKD5 were higher than those in control group and hs-CRP levels were gradually increased from the stage of CKD3 to CKD5（P 〈 0.05）.Then sCD146 levels in the urine were positively correlated with serum sCD146,Scr,BUN,β2-microglobulin,CystainC and hs-CRP（r = 0.697,0.699,0.871,0.755,0.524,0.414 respectively）,and negatively correlated with eGFR,hemoglobin and Alb（r =-0.787,-0.601,-0.298 respectively）.Conclusion：sCD146 in the urine is closely correlated with renal function.It may greatly show renal impairment in the early stage.sCD146 also may closely associate with inflammation in patients with CKD.Serum and urine levels of sCD146 were differentially expressed,which may be involved in the immune mechanism of the damage in the kidney.