IgA肾病患儿血管紧张素Ⅱ变化的临床意义

Clinical significance of angiotension II in children with IgA nephropathy

目的探讨血管紧张素Ⅱ(AngⅡ)在IgA肾病(IgAN)中的临床意义。方法选择2008年5月至2012年12月间经肾活检诊断为原发性IgAN的30例患儿(IgAN组)及同期健康体检的30例儿童(对照组);以ELISA法检测并比较IgAN组与对照组的血和尿AngⅡ水平;以免疫组织化学法检测IgAN组肾组织中AngⅡ表达,分析IgAN组肾组织中的AngⅡ与各临床指标间的相关性。结果 IgAN组的尿AngⅡ水平高于对照组,差异有统计学意义(P<0.05)。IgAN组的尿AngⅡ水平与尿微量白蛋白水平呈正相关(r=0.37,P=0.046);不同病理分级IgAN患儿的尿及肾组织AngⅡ表达差异均有统计学意义(P<0.05)。IgAN患儿的病理分级与尿AngⅡ水平及肾组织AngⅡ表达呈显著正相关(r=0.69,0.79,P均=0.000)。结论 IgAN患儿尿AngⅡ水平升高,并与病理分级和尿微量白蛋白水平正相关,检测尿AngⅡ可能对评定IgAN疾病进展及判断预后有实用价值。

objective To investigate the clinical significance of the changes of angiotension Ⅱ （Ang Ⅱ ） in children with IgA nephropathy （IgAN）. Methods Thirty children diagnosed as primary IgA nephropathy by renal biopsy （IgAN group） and 30 healthy children （control group） were recruited from May 2008 to December 2012. The serum and urine Ang Ⅱ were measured by ELISA and compared between IgAN group and control group. The Ang Ⅱ expression in the renal tissue of IgAN group was detected by immuno-histochemical method, and was correlated with other clinical data.. Results Urine Ang Ⅱ was significantly higher in the primary IgAN group than that of control group （P 〈 0.05）; Ang Ⅱ expression in the urine is positively correlated with proteinuria （r=0.37, P=0.046）, and is associated with the severity of clinical presentation; Ang Ⅱ expression in kidney tissue increased with the severity of the renal histopathologic grading （r=0.69, 0.79, P=-0,000）, while Ang Ⅱ in blood and proteinuria, Ang Ⅱ expression in kidney tissue were not significantly correlated with the number of crescents. Conclusions Urine Ang Ⅱ in children with IgAN is significantly correlated with the severity of the pathologic stage and the level of proteinuria. Urine Ang Ⅱ detection may be useful to assess the progress and prognosis of chronic kidney disease.