原发性肾病综合征患儿血清可溶性尿激酶型纤溶酶原激活物受体和可溶性髓样细胞触发受体-1表达变化的意义

Expression changes of soluble urokinase - type plasminogen activator receptor and soluble triggering receptors expressed by myeloid cell -1 in serum of children with primary ncphrotic syndrome and their clinical significance

目的探讨原发性肾病综合征（PNS）患儿血清可溶性尿激酶型纤溶酶原激活物受体（suPAR）和可溶性髓样细胞触发受体-1（sTREM-1）表达变化及临床意义。方法选取2014年6月至2016年9月在潍坊医学院附属益都中心医院住院治疗的初诊PNS患儿92例，根据有无急性肾小管坏死分为急性肾损伤组（27例）和非急性肾损伤组（65例）。根据病理学类型分为系膜增生性肾小球肾炎（30例）、局灶性节段性肾小球硬化（23例）、膜性肾病（18例）、微小病变型（14例）和膜增生性肾小球肾炎（7例）。同期选取健康儿童45例作为健康对照组。收集临床资料，采用酶联免疫吸附试验（ELISA法）检测PNS患儿和健康对照组儿童血清suPAR和sTREM-1水平。结果PNS患儿总胆固醇（TC）、三酰甘油（TG）、尿酸（UA）、尿蛋白/肌酐、24 h尿蛋白量、尿N-乙酰-β-氨基葡萄糖苷酸（NAG）和尿酸球蛋白（β2-MG）均高于健康对照组，而血清蛋白（ALB）低于健康对照组，差异均有统计学意义（均P〈0.05）；PNS患儿血清suPAR和sTREM-1水平分别为（133.09±62.48） ng/L、（79.29±34.68） ng/L，均高于健康对照组[（31.11±11.61） ng/L、（25.08±8.10） ng/L]，差异均有统计学意义（t＝51.714、49.435，均P＝0.000）；急性肾损伤组患儿血清suPAR和sTREM-1水平分别为（188.82±32.21） ng/L、（109.11±24.78） ng/L，均高于非急性肾损伤组[（75.96±28.69） ng/L、（52.23±14.07） ng/L]和健康对照组[（31.11±11.61） ng/L、（25.08±8.10） ng/L]，差异均有统计学意义（F＝16 739.607、10 487.256，均P＝0.000）；局灶性节段性肾小球硬化和膜增生性肾小球肾炎患儿血清suPAR和sTREM-1水平均高于微小病变型、膜性肾病和系膜增生性肾小球肾炎患儿，差异均有统计学意义（均P〈0.05）；Pearson相关分析结果显示，血清suPAR和sTREM-1水平与TC、TG、尿蛋白/肌酐、24 h尿蛋白量、尿NAG和β2-MG均呈正相关（均P〈0.05），而与ALB呈负相关（P〈0.05）。结论PNS患儿血清suPAR和sTREM-1水平升高，且与急性肾损伤及病理学类型有关，在一定程度上可反映肾小管病变程度和肾脏功能。

Objective To investigate the expression changes of soluble urokinase - type plasminogen activator receptor （suPAR） and soluble triggering receptors expressed by myeloid cell- 1 （sTREM -1 ） in serum of children with primary nephrotic syndrome（PNS） and their clinical significance. Methods A total of 92 cases of newly diag- nosed PNS children were selected in Central Hospital of Yidu Affiliated to Weifang Medical College from June 2014 to September 2016. According to presence or absence of acute tubular necrosis, they were divided into acute renal injury group （27 cases） and nonacute renal injury group （65 cases）. According to pathology type, they were divided into mesangial proliferative glomerulonephritis （30 cases）,focal segmental glomerulosclerosis （23 cases ） , membranous nephropathy （18 cases）, minimal change disease （14 cases） and membrane proliferative glomerulonephritis （7 cases）. In the same period,45 healthy children were selected as the healthy control group. The clinical data were collected. The serum levels of suPAR and sTREM - 1 were measured by adopting enzyme - linked immunosorhent assay （ELISA）. Results The levels of total cholesterol （ TC ）, triglycerides （ TG）, uric acid （ UA ）, urinary protein/creatinine, 24 h urinary protein,urinary N- acetyl-β- glucosaminidase （NAG） and β2 -microglobulin（MG） in children with PNS were higher than those in the healthy control group,while serum albumin（ALB） was lower than that in the healthy control group, and the differences were statistically significant （ all P 〈 0.05 ）. The serum levels of suPAR and sTREM - 1 in PNS patients were （ 133.09 ± 62.48 ） ng/L and （79.29 ± 34.68 ）, respectively, which were significantly higher than those in the healthy control group[ （31.11 ± 11.61 ） ng/L and （25.08 ± 8.10 ） ng/L] （t = 51.714,49. 435 ; all P = 0. 000）. The serum levels of suPAR and sTREM - 1 in acute renal injury group were （ 188.82 ± 32.21 ） ng/L and （109.11 ±24.78） ng/L, respectively,which were significantly higher than those in non -acute renal injury group （75.96 ±28.69） ng/L and （52.23 ± 14.07） ng/L] and healthy control group [（31. 11 ± 11.61 ） ng/L and （ 25.08 ± 8.10） ng/L ] （ F = 16 739. 607,10 487. 256, all P = 0. 000）. The serum levels of suPAR and sTREM - 1 in children with focal segmental glomerulosclerosis and membrane proliferative glomerulonephritis were higher than those with minimal change disease, membranous nephropathy and mesangial proliferative glomerulonephritis, and the differences were statistically significant （ all P 〈 0.05 ）. Pearson correlation analysis results showed that the serum levels of suPAR and sTREM - 1 were positively correlated with TC, TG, urinary protein/creatinine, 24 h urinary protein, urinary NAG and β2 - MG （ all P 〈 0.05 ）, while negatively correlated with ALB （ P 〈 0.05 ）. Conclusions The serum levels of suPAR and sTREM - 1 are elevated in children with PNS, and which are related with acute renal injury and pathological type, which can reflect the degree of renal tubular disease and kidney function to a certain extent.