血清羟脯氨酸浓度和脯肽酶活性在判断肾纤维化病程中的意义

Serum hydroxyproline and prolinase are useful for diagnosis of renal fibrosis

目的 :探讨血清羟脯氨酸浓度和脯肽酶活性在反映肾纤维化中的意义。方法 :经肾活检证实的有(纤维化组)和无(无纤维化组)肾小球硬化与肾间质纤维化的肾脏病人各10例 ,健康献血员(对照组)10例 ,测血清羟脯氨酸浓度、血清脯肽酶活性等指标。结果 :纤维化组血清羟脯氨酸浓度显著高于无纤维化组(P<0.001)和健康对照组(P<0.001) ,以此指标显著增高判断肾纤维化 ,敏感性100 % ,特异性91 % ,假阳性9 % ,与肾活检符合率95 %。纤维化组血清脯肽酶活性亦显著高于无纤维化组(P<0.05)和健康对照组(P<0.05) ,以此指标显著增高判断肾纤维化 ,敏感性80 % ,特异性100 % ,未发现假阳性 ,与肾活检符合率90 %。血清羟脯氨酸浓度与患者血清肌酐浓度、纤维化肾小球比率和病变肾小管、肾间质比率显著正相关。结论 :血清羟脯氨酸浓度和脯肽酶活性 ,可作为判断肾脏病人肾纤维化的无创性检查指标 ,尤其适用于有肾活检禁忌症的病人。

Objective: To explore the role of serum hydroxyproline concentration and prolinase activity in the diagnosis of renal fibrosis. Methods: Twenty patients with renal diseases confirmed by biopsy were divided into non fibrotic group and fibrotic group with 10 in each. Other 10 healthy blood donors were employed as the control. Before the venous blood samples were collected, all the subjects were banned for meat in food for 3 days. The serum hydroxyproline concentration was measured with Beckman 6300 gold system amino acid analyzer and the prolinase activity was determined with enzyme substrate method. Other indexes were measured with routine methods. Results: The serum hydroxyproline concentration was significantly higher in fibrotic group than in the non fibrotic and control groups (P<0.001). The increase of serum hydroxyproline predicted the renal fibrosis with 100% sensitivity, 91% specificity, 9% pseudo positivity and 95% accordance with renal biopsy. The serum prolinase activity was also markedly higher in fibrotic group than in non fibrotic and control groups (P<0.05). The increase of proline activity predicted the renal fibrosis with 80% sensitivity, 100% specificity and 90% accordance to renal biopsy. Conclusion: The serum hydroxyproline concentration and prolinase activity might be used as 2 parameters of non traumatic examination for diagnosis of renal fibrosis. The two are especially suitable for those patients with renal diseases who an no receive renal biopsy.