血清免疫球蛋白轻链在慢性肾病病情监测及预后判断中的作用

Role of serum immunoglobulin light chains in monitoring and predicting prognosis of chronic kidney disease

目的探究血清免疫球蛋白轻链在慢性肾病(CKD)患者的病情监测和预后判断中的作用。方法选取CKD患者1 512例,其中慢性肾功能不全患者743例(CRI组),慢性肾功能衰竭患者155例(CKF组),肾病综合征患者614例(NS组),尿路感染患者73例(UTI组);选取同期的健康体检者50例为对照组。用免疫散射比浊法分别检测其血尿κ和λ轻链的水平。结果 NS组患者血κ和λ轻链的水平均低于CKF组和CRI组患者,差异有统计学意义(P<0.01)。CRI、CKF、NS、UTI组的尿κ和λ轻链的水平均高于对照组,差异有统计学意义(P<0.01)。与UTI组(0)和对照组(0)相比,NS组(67.9%)、CKF组(65.6%)和CRI组(51.9%)的尿κ、λ水平同时阳性比率明显升高,差异有统计学意义(P<0.05),且NS组和CKF组的尿κ、λ水平同时升高比率均高于CRI组,差异有统计学意义(P<0.05),但两者之间无明显差异。结论 CKD患者检测血尿κ和λ轻链水平的异常在诊断CKD、判断肾小球和肾小管损伤程度、判断病情及改善预后中有重要的参考价值。

Objective To evaluate the role of serum immunoglobulin light chains in monitoring and predicting prognosis of chronic kidney disease. Methods Totally 1512 chronic kidney patients(CKD） were assigned into 3 groups,chronic renal insufficiency group(Group CRI,n = 743）,chronic renal failure group(Group CKF,n = 155）,and nephritic syndrome group(Group NS,n = 614）. Meanwhile,73 cases of urinary tract infection group(Group UTI） and 50 healthy participants for physical examination(Group Control） were also selected. Immune scatter turbidity was applied to detect the levels of urinary free light chains and serum light chains. Results The levels of serum free κ and λ light chains in Group NS was significantly lower than those in Group CKD and CKF(P 〈0. 01）. The levels of urine free κ and λ light chains in Group CRI,CKF,NS and UTI were significantly higher than those in Group Control(P 〈0. 01）. Compared with Group UTI(0） and Control(0）,the proportions of the patients with urinary κ and λ free light chains double positive were significantly higher in Group CRI(51. 9%）,CKF(65. 6%） and NS(67. 9%）(P〈 0. 05）. And they were also significantly higher in Group NC and CKF than that in Group CRI(P〈 0. 05）. Conclusion Detection of the level of urinary free light chains has a profound impact in the aspect of diagnosing chronic kidney disease,evaluating patient＇s condition and the degree of renal corpuscle and tubular injuries.