尿视黄醇结合蛋白、N-乙酰-β-D-氨基葡萄糖苷酶及尿蛋白检测在IgA肾病患者肾小管间质损害中的临床意义

The clinical significance of urine RBP, NAG and protein on renal tubular interstitial lesions in patients with IgA nephropathy

目的 探讨尿视黄醇结合蛋白（RBP）、N-乙酰-β-D-氨基葡萄糖苷酶（NAG）及24小时尿蛋白定量（UPE）等指标判断IgA肾病（IgAN）患者肾小管间质损害程度的临床意义.方法 收集我院2010年5月～2013年2月114例住院IgAN患者的临床及病理资料,依据Lee氏病理分级系统将患者分为Lee I～Ⅱ级27例（A组）、LeeⅢ级46例（B组）和LeeⅣ～V级41例（C组）,分析不同分级IgAN肾小管间质病变情况与尿RBP、NAG、UPE等指标之间的相关性.结果 各组间血红蛋白（Hb）、白蛋白（ALB）、前白蛋白（pre-ALB）、血肌酐（SCr）、尿素氮（BUN）、总胆固醇（TC）、UPE、尿RBP及NAG等指标比较差异有统计学意义（P＜0.01）,镜下血尿及高血压的发生率随病理程度加重而上升（P＜0.01）,肾小管萎缩、肾间质炎细胞浸润、肾间质纤维化及动脉硬化在各组间比较差异均有统计学意义（P＜0.01）,相关性分析显示尿RBP、NAG与肾小管萎缩、肾间质炎症细胞浸润、肾间质纤维化及动脉硬化程度呈正相关;UPE与肾小管萎缩程度呈负相关（r=-0.213,P＜0.05）,尿RBP、NAG水平与eGFR呈负相关.结论 IgAN患者高血压及血尿发生率、Hb、ALB、TC、肾功能、RBP、NAG、UPE等指标与肾脏病理损伤程度有关,尿RBP、NAG及UPE联合检测对判断肾小管病理损伤程度及肾功能有临床意义.

Objective To explore the clinical significance of urine RBP,NAG and 24 h urinary protein excretion（UPE） in judging the condition of renal tubular interstitial lesions in patients with IgA nephropathy（IgAN）.Methods 114 patients with IgAN of clinical and pathological data in our hospital from May 2010 to February 2013 were analyzed,according to Lee＇ s grading system Lee Ⅰ-Ⅱ 27 cases （group A）,Lee Ⅲ level 46 cases（group B） and Lee IV-V level 41 cases （group C）,analysis the correlation of different pathological type of IgAN renal tubular interstitial damage with urine RBP,NAG and UPE.Results There had significant differences in hemoglobin （Hb）,SCr,BUN,albumin （ALB）,pre-albumin（Pre-ALB）,total cholesterol（TC）,UPE,urine RBP and NAG among groups（P 〈0.01）.The incidence of microscopic hematuria and hypertension increased incidence （P 〈 O.O1） with the pathological lesion degree,there were statistically significant（P 〈 0.01） in renal interstitial inflammatory cell infiltration,renal tubular atrophy comparison between renal interstitial fibrosis among groups.The correlation analysis showed that there were positive correlations of urine RBP and NAG with renal interstitial inflammatory cell infiltration,renal tubular atrophy,renal fibrosis and the hardening of arteries.There were negative correlations of UPE with renal tubular atrophy （r =-O.213,P 〈 0.05）,there were negative correlations of urine RBP,NAG with eGFR.Conclusion The incidence of hypertension and hematuria,Hb,ALB,TC,renal function,UPE,RBP and NAG are closely related to the degree of renal pathological injury.Urine RBP,NAG and UPE have important significance in judging the degree of renal tubule pathologic damage and renal function.