联合尿液生物学标志物检测儿童巨细胞病毒感染相关肾损伤的临床观察

Clinical study on combined urine biomarker detection in kidney injury of child CMV infection

目的探讨尿液生物学标志物在儿童巨细胞病毒(CMV)感染所致肾损伤以及治疗前后的变化。方法收集我科CMV感染的患儿50例作为患儿组,对照组选择健康体检儿童35例,患儿组在入院初检测血肌酐(Scr)、血尿素氮(BUN)、血β_2微球蛋白(MG)、肝功能、血CMV-Ig M,血及尿液CMV-PCR、脑干电测听(BAEP)、头CT、尿常规,尿液中的尿液转铁蛋白(TFR)、微量白蛋白(mALb)、β_2MG、α_1MG和N-乙酰-β-D氨基葡萄糖苷酶(NAG),合并CMV肺炎吸取痰液检测CMV-PCR。所有患儿均给予更昔洛韦治疗,5 mg/kg加入0.9%氯化钠溶液(5 m L/kg)中,静脉滴注,12 h 1次,每次滴注不少于1 h,持续14 d,复查尿液TFR、mALb、β_2MG、α_1MG和NAG。结果患儿组与对照组尿液mALb、TFR差异无统计学意义,患儿组尿液α_1MG、NAG、β_2MG高于对照组,患儿组予更昔洛韦抗病毒治疗2周后,复查尿液α_1MG、NAG、β_2MG治疗后较治疗前降低,而尿液mALb、TFR治疗前后差异无统计学意义。结论尿液β_2MG、α_1MG、NAG的联合检测对于早期发现儿童CMV肾损害有很好的提示作用。

Objective To explore changes of urine transferrin （TFR）,micro albumin （mALb）,β2 microspheres protein （MG）,α1MG and N-acetylβ-D amino group （NAG） in children with kidney injury induced by cytomegalovirus （CMV） infec？tion, and the outcome after treatment. Methods Fifty children with CMV infection were used as case group, and 35 chil？dren of convalescence stage of upper respiratory tract infection were used as control group. The serum levels of creatinine （Scr）, blood urea nitrogen （BUN）,β2MG, liver function, CMV-IgM, CMV-PCR and brainstem auditory （BAEP）, head CT and urine routine test, urine TFR, mALb,β2MG,α2MG and NAG were detected. The sputum CMV-PCR was detected if childrencombined with CMV pneumonia. Ganciclovir （5mg/kg） was given to two groups, 1/12 h i.v. for 14 d. The urine TFR,mALb,β2MG, α2MG and NAG were detected again after treatment. Results There were no significant differences in the urine mALb and TFR between the two groups. The urine levels ofα1MG, NAG andβ2MG were higher in case group than those of control group. The urine levels ofα1MG, NAG andβ2MG were decreased after 2-week treatment in case group. There were no significant differences in urine mALb and TFR before and after treatment. Conclusion The combined detection ofβ2MG,α1MG and NAG can predict CMV kidney damage in children at a early stage.