摘要
目的研究中性粒细胞明胶酶相关脂质转运蛋白(NGAL)在原发性肾病综合征患儿尿中的水平及其意义。方法原发性肾病综合征初治患儿34例,经口服泼尼松足量治疗4周尿蛋白未转阴患者归入糖皮质激素耐药型肾病综合征(SRNS)组,尿蛋白转阴患者归入糖皮质激素敏感型肾病综合征(SSNS)组。所有病例在口服泼尼松治疗前、治疗1周、2周、3周、4周时分别收集晨起中段尿,采取ELISA法检测尿液NGAL浓度,同时测得尿中肌酐(Cr)值,采用尿Cr排出量来校正单次尿NGAL水平,比较两组间尿NGAL与Cr比值的表达差异。结果与SRNS组比较,SSNS组病例尿标本中NGAL/Cr比值在泼尼松治疗3、4周时明显下降(P<0.05);与SRNS组比较,SSNS组病例尿标本中β2-MG/Cr比值在泼尼松治疗4周时才开始明显下降。SSNS与SRNS两组病例尿NGAL/Cr与尿蛋白/Cr比值呈正相关(r=0.510,P<0.01)。ROC曲线下分析结果显示,用药3周后尿NGAL/Cr诊断截点为0.043时,敏感度和特异度分别为100%和79.2%。结论 SRNS患儿尿液中NGAL/Cr比值持续维持于高水平,而SSNS患儿尿液中NGAL/Cr比值在泼尼松治疗后逐渐下降,且其下降时间早于β2-MG/Cr比值,提示动态监测尿液中NGAL/Cr比值,有助于早期判断原发性肾病综合征的泼尼松治疗效应。
Objective To investigate the urinary neutrophil gelatinase-associated lipocalin (NGAL) concentration in children with idiopathic nephrotic syndrome (INS) and its clinical significance. Methods Thirty-four children newly diagnosed with INS received oral prednisone for 4 weeks. Patients whose urinary protein did not become negative were classified as steroid-resistant nephrotie syndrome (SRNS) group, while those whose urinary protein did become negative were classified as steroid-sensitive nephrotie syndrome (SSNS) group. Morning midstream urine specimens were collected from all patients before use of prednisone and after 1,2, 3, and 4 weeks of treatment with prednisone. Enzyme-linked immunosorbent assay was used to measure the urinary NGAL concentration. Meanwhile, urinary ereatinine (Cr) concentration was measured, and urinary NGAL concentration in a single urine collection was adjusted according to the urinary Cr excretion. The two groups were compared in terms of urinary NGAL/Cr ratio. Results Compared with the SRNS group, the SSNS group bad significantly decreased urinary NGAL/Cr ratios after 3 and 4 weeks of prednisone treatment (P 〈 0.05). Compared with the SRNS group, the SSNS group had a significantly decreased urinary 132-MG/Cr ratio after 4 weeks of prednisone treatment (P 〈 0.05). In both groups, urinary NGAL/Cr ratio was positively correlated with urinary protein/Cr ratio (r = 0. 510, P 〈0.01 ). The results of ROC curve analysis showed when diagnostic cut-off point of urinary NGAI./Cr was 0.043 by 3 weeks after treatment, sensitivity and specificity achieved 100% and 79.2% respectively. Conclusions Urinary NGAL/Cr ratio remains high in children with SRNS, while this ratio decreases gradually during prednisone treatment in children with SSNS, and it falls ahead of urinary 132-MG/Cr ratio. These results suggest that dynamic monitoring of urinary NGAIJCr ratio is useful for early judgment of response to prednisone in patients with INS.
出处
《中国当代儿科杂志》
CAS
CSCD
北大核心
2013年第7期541-545,共5页
Chinese Journal of Contemporary Pediatrics