IgA肾病肾功能正常患者血浆褪黑素水平变化分析

Plasma Melatonin Levels in Patients with IgA Nephropathy

目的探讨IgA肾病肾功能正常患者血浆褪黑素水平的变化,为褪黑素用于治疗IgA肾病提供科学依据。方法选择2009年9月—2012年5月中山大学附属第五医院及合作医院肾内科收治的肾功能正常的IgA肾病患者(IgA肾病组)48例及尿检、血清肌酐和尿素氮均正常的健康者22例(对照组)。IgA肾病组又分为小管间质基本正常组(n=27)和小管间质明显病变组(n=21)。采用酶联免疫吸附法(ELISA)测定各组受试者血浆褪黑素及尿液单核细胞趋化因子-1(MCP-1)水平。结果 IgA肾病组患者血浆褪黑素水平为(64.05±29.23)ng/L,低于正常对照组的(80.54±35.12)ng/L(t=2.06,P<0.05)。小管间质明显病变组血浆褪黑素水平为(53.39±30.00)ng/L,低于小管间质基本正常组的(72.34±26.26)ng/L(t=2.33,P<0.05)。IgA肾病患者尿液MCP-1水平为(40.27±24.22)ng/L,高于对照组的(26.86±8.18)ng/L(t=3.43,P<0.05)。小管间质明显病变组尿液MCP-1水平为(50.53±31.05)ng/L,高于小管间质基本正常组的(32.30±12.94)ng/L(t=2.53,P<0.05)。IgA肾病患者血浆褪黑素水平与尿液MCP-1水平呈负相关(r=-0.363,P<0.05)。结论 IgA肾病肾功能正常患者血浆褪黑素水平较正常人群降低,小管间质明显病变组血浆褪黑素水平较小管间质基本正常组降低,IgA肾病肾功能正常患者尿液MCP-1水平随血浆褪黑素水平降低而升高,提示血浆褪黑素水平的降低引起炎症免疫反应失调,导致肾脏表达和分泌MCP-1增加,进而参与了IgA肾病的进展。补充外源性褪黑素可能为治疗IgA肾病具有潜力的方法。

Objective To study blood plasma levels of melatonin in patients with immunoglobnlin A nephropathy （IgAN） to provide a basis for treatment of patients with IgAN complicated by melatonin. Methods From September 2009 to May 2012, 48 IgAN patients admitted to the Fifth Affiliated Hospital of SUN Yat - sen University and cooperation hospitals （IgAN group） and 22 healthy subjects （control group） were enrolled in this study. IgAN group were subdivided into groups norreal （ with normal tubulointerstitial, n = 27 ）, lesion （ with tubulointerstitial lesion, n = 21 ）. Enzyme - linked immunosorbent assay （ELISA） was used to determine plasma melatonin level and urine melatonin monocyte ehemotactic factor - 1 （ MCP - 1 ）. Results The melatonin level was lower in IgAN group [ （64. 05 ±29. 23） ng/L） than in control group [ （80. 54 ±35.12） ng/ L （t =2. 06, P 〈0. 05） ], lower in lesion group [ （53. 39 ±30. 00） ng/L] than in normal group [ （72. 34 ±26. 26） ng/L （t = 2. 33, P 〈 0. 05 ） ]. MCP - 1 level was higher in IgAN group （ （40. 27 ±24. 22） ng/L] than in control group [ （26. 86 ± 8.18） ng/L, t=3.43, P〈0.05], higher in lesion group [ （50.53 ±31.05） ng/L] than in normal group [ （32.30 ±12. 94） ng/L, t =2. 53, P 〈0. 05）. The melatonin level was negatively correlated with MCP - 1 in IgAN group （r = -0. 363, P 〈 0. 05）. Conclusion Plasma melatonin level is lower in IgAN patients than in normal population, lower in those with tubulointerstitial lesion than in those with normal tubulointerstitial. MCP - 1 rises with the decrease of plasma melatonin, suggesting that decreased melatonin leads to inflammatory immune response disorders and causes the increase of kidney MCP - 1 expression and secretion, thus involved in the progression of IgAN. Exogenous melatonin may a potential method for IgAN treatment.