肾近端小管损伤标志物在特发性膜性肾病中应用的研究进展

Research Progress in Application of Molecular Markers of Renal Tubular Injury in Idiopathic Membranous Nephropathy

特发性膜性肾病是以一种以肾小球病变为主的疾病。肾小球疾病的发展和预后与肾小球本身的损害、近端肾小管功能损害的严重程度密切相关,已经应用于临床的常见近端肾小管损伤分子有β_2-微球蛋白、N-乙酰-β-D-氨基葡萄糖苷酶、视黄醇结合蛋白等,这些分子能较好地反映病情的严重程度。近几年来,肾损伤分子1、中性粒细胞明胶酶相关脂质运载蛋白等新兴的近端肾小管损伤标志物开始出现,它们在特发性膜性肾病中的研究较少,表达特点尚未完全明确。现有的很多研究所纳入的病例数相对较少,缺乏大型的多中心随机对照试验,关于近端肾小管损伤分子在各种慢性肾脏疾病中应用的对比研究也相对缺乏。近端肾小管损伤分子的检测是无创性的,其水平能较好地反映肾小管间质损伤情况,有的近端肾小管损伤分子可以在判断患者预后方面能起到一定作用,因此在临床诊疗中有一定的指导作用。

Idiopathic membranous nephropathy(IMN)is a primary glomerular disease.The progression of IMN is not only characterized by glomerular dysfunction but also the dysfunction of the proximal renal tubular.The commonly used clinical tubular injury molecules includeβ2-microglobulin,N-acetyl-β-D-glucosaminidase and retinol binding protein,which can better reflect the severity of the disease.New biomarkers such as kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin have emerged as markers of proximal renal tubular damage.There were few small sample size studies in which these biomarkers have been studied.Large-scale multicenter randomized controlled trials are generally missing and comparative uses of these biomarkers in kidney diseases have not yet been reported.These biomarkers could offer the much needed non-invasive means of assessing the severity of tubulointerstial injury.They may also play key roles both in the diagnosis and treatment,and provide a certain reference for the prognosis prediction.