尿蛋白谱相关检测在特发性膜性肾病预后中的意义

Significance of detection of urinary protein spectrum in prognosis of idiopathic membranous nephropathy

目的探讨尿β2微球蛋白（β2-MG）、尿α1微球蛋白（α1-MG）、尿免疫球蛋白IgG、尿N-乙酰-β-D-葡萄糖苷酶（NAG）在特发性膜性肾病（IMN）患者预后的意义。方法选择2011年1月至2014年9月在新疆维吾尔自治区人民医院经临床及病理资料确诊的IMN患者60例,绘制受试者工作曲线（ROC）,采用Cox风险比例模型进行单因素及多因素的预后影响因素分析,采用Kaplan-Meier曲线评估生存状况。结果 （1）IMN患者60例,其中男41例,女19例,男女之比为2.2∶1,主要表现为肾病综合征（76.7%）,随访过程中,27例（45%）患者尿蛋白缓解。（2）绘制尿β2-MG、尿IgG、尿NAG及α1-MG的ROC曲线,其曲线下面积（AUC）分别为0.786、0.769、0.659和0.647,阈值分别为1.17 mg/L、24.98 mg/L、40.34 U/L和40.35 mg/L。行多因素分析得出尿β2-MG、尿IgG是影响预后的危险因素,P值分别为0.046和0.003,95%置信区间分别为1.105~1.137和1.015~1.076。结论 IMN以男性多见,部分患者可以发生尿蛋白缓解。尿β2-MG、尿IgG在对疾病的预后评估上有一定的价值,并且为影响肾功能下降的独立危险因素,对于高排出尿β2-MG、尿IgG的IMN患者应积极给予降尿蛋白治疗。

Objective To explore the prognostic value of urine beta 2 microglobulin （β2-MG）, urine alpha 1 microglobulin （α1-MG）, urine IgG, urinary N-acetyl-beta-D-glycosidase enzymes （NAG） in patients with idiopathic membranous nephropathy （IMN）. Methods Sixty patients who were diagnosed for idiopathic membranous nephropathy by clinical or pathological data in People＇s Hospital of Xinjiang Uygur Autonomous Region from January 2011 to September 2014 were involved in this study. Receiver operating characteristic （ROC） curve was drew to determine the threshold. The Cox model was used to analyze the prognosis of influence factors, the survival rate of preset end point was assessed by Kaplan Meier curves. Results （1） Among 60 patients, there were 41 cases of men and 19 cases of women, the ratio of male and female was 2.2∶1, main clinical manifestation was nephrotic syndrome （76.7%）. In the process of follow-up, urine protein of 27 cases （45%） was eased. （2） Areas under the curve （AUC） of β2-MG, IgG, NAG and α1-MG were 0.786, 0.769, 0.659 and 0.647, threshold values were 1.17 mg/L, 24.98 mg/L, 40.34 U/L and 40.35 mg/L. Line of multi-factor analysis showed that urine β2-MG and urine IgG had statistically significant, P values were 0.046 and 0.003, 95% confidence intervals were 1.105-1.137 and 1.015-1.076. Conclusion The patients with IMN were main for men, some patients can occur different degree of ease. β2-MG and urine IgG has a certain value on the evaluation of prognosis, and is also the independent risk factors of renal dysfunction, therefore, massive excretion of urine IgG and β2-MG of IMN should be given positive treatment.