儿童原发性肾病综合征尿足细胞标志蛋白、足细胞裂孔膜蛋白与尿蛋白关系的研究

The research relationship between urinary podocalyxin,nephrin and urinary protein in children with primary nephrotic syndrome

目的探索儿童原发性肾病综合征(NS)蛋白尿与足突损伤间的关系。方法选择2013年9月至2014年3月于哈尔滨市儿童医院泌尿内科住院的20例原发性NS患儿为研究对象,并纳入肾病组(n=20)。选择同期于该院门诊体检的10例健康儿童为正常对照组(n=10)。研究组患儿均接受肾上腺糖皮质激素治疗。应用酶联免疫吸附试验(ELISA)方法检测肾病组患儿不同观察时刻及正常对照组儿童随机尿足细胞标志蛋白(PCX)、足细胞裂孔膜蛋白(nephrin)水平,采用免疫比浊法及比色法测定患儿尿蛋白及尿肌酐水平,并计算尿蛋白、尿肌酐比值。结果 1肾病组患儿尿PCX、nephrin水平和尿蛋白、尿肌酐比值均显著高于正常对照组,且差异有统计学意义(t=2.612,2.843,2.972;P<0.01)。2肾病组患儿激素治疗期间尿PCX、nephrin水平和尿蛋白/尿肌酐比值总体均呈下降趋势。相邻观察时刻的尿PCX与nephrin水平比较,差异均无统计学意义(P>0.05)。治疗第8天尿PCX和nephrin水平较治疗前显著下降,且差异有统计学意义(t=1.934,2.093;P<0.05)。治疗第6天尿蛋白、尿肌酐比值较第4天和治疗前显著下降,且差异也有统计学意义(t=2.042,2.120;P<0.05)。3尿PCX、nephrin水平分别与尿蛋白、尿肌酐比值呈正相关关系(r=0.91,0.92;P<0.01)。结论尿PCX、nephrin水平随NS的恢复而逐渐下降,与尿蛋白指标有良好的相关性,对其进行监测可动态观察足细胞变化,对判断肾小球的损伤及恢复情况有一定的临床意义。

Objective To identify the relationships between proteinuria and foot process damage of primary nephrotic syndrome（NS）.Methods From September 2013 to March 2014,a total of 20 patients with primary NS were selected as the research group（n=20）in Harbin Children′s Hospital.Meanwhile10 healthy children were selected as normal control group（n=10）.The children in research group were treated with adrenal cortex hormone therapy.The levels of podocalyxin（PCX）and nephrin at different observation time in the nephropathy group and at random interval in normal control group were detected by enzyme-linked immunosorbent assay（ELISA）method.The serum levels of urine protein and urine creatinine were measured by the method of turbidimetric inhibition immuno assay and colorimetry.Results 1The levels of urinary PCX,nephrin and urine protein/creatinine in research group were significantly higher than those of the normal control group（t=2.612,2.843,2.972;P〈0.01）.2PCX,nephrin and urine protein/urine creatinine levels were decreased during the treatment in research group.There was no significant difference in urine PCX and nephrin between every couple of adjacent observation time（P〉0.05）.The levels of urinary PCX and nephrin were significantly decreased between the eighth day and before treatment,and the differences were statistically significant（t=1.934,2.093;P〈0.05）.The levels of urinary protein/urine creatinine were significantly decreased between the sixth day and the forth day or before treatment,and the differences were also statistically significant（t=2.042,2.120;P〈0.05）.3PCX and nephrin levels were positively correlated with urine protein/urine creatinine levels（r=0.91,0.92;P〈0.01）.Conclusions The levels of PCX and nephrin decreased with the recovery of NS,and it had a good correlation with urinary protein index,carrying on a quantitative detection of dynamic observation podocyte changes.It has certain clinical significance for judging the glomerular damage and recovery.