尿血管紧张素原与肾脏间质炎性细胞浸润的相关性研究

Correlation Study of Urinary Angiotensinogen and Renal Interstitial Inflammatory Cell Infiltration

目的分析尿血管紧张素原(uAGT)在肾衰竭患者中的表达及其与肾脏间质炎性细胞浸润的相关性。方法选择2014年12月—2016年4月在郑州大学第一附属医院肾内科住院并行肾活检的肾衰竭患者77例为肾衰竭组,选择同时期本院体检健康者12例作为对照组。收集肾衰竭组和对照组的临床资料,收集肾衰竭组的病理资料,球性硬化、间质炎性细胞浸润、间质纤维化和小管萎缩的半定量积分采用Katafuchi评分标准,uAGT的测定采用ELISA。分析uAGT与临床、病理资料的相关性,绘制uAGT诊断不同肾脏病理损伤类型的受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC)。结果肾衰竭组血红蛋白(Hb)、清蛋白(Alb)、估算肾小球滤过率(eGFR)、高密度脂蛋白(HDL)低于对照组,而尿素、尿酸、肌酐、总胆固醇(TC)、三酰甘油(TG)、uAGT高于对照组(P<0.05)。肾衰竭患者uAGT与Hb、Alb、尿酸、eGFR呈负相关(r_s=-0.427、-0.379、-0.266、-0.254,P<0.05),与尿蛋白定量呈正相关(r_s=0.445,P<0.001)。u AGT与球性硬化积分(r_s=0.270,P=0.018)、间质炎性细胞浸润积分(r_s=0.401,P<0.001)、间质纤维化积分(r_s=0.273,P=0.016)、小管萎缩积分(r_s=0.272,P=0.017)呈正相关。uAGT诊断间质球性硬化、炎性细胞浸润、间质纤维化、小管萎缩的AUC分别为0.627、0.689、0.627、0.639。结论 uAGT在肾衰竭患者中显著升高,与肾脏间质炎性细胞浸润呈正相关,能反映其严重性,且对肾脏间质炎性细胞浸润的诊断价值较高,可作为肾脏间质炎性细胞浸润的无创评价指标。

Objective To analyse the expression of urinary angiotensinogen(uAGT)and its relationship with renal interstitial inflammatory cell infiltration in patients with kidney failure. Methods The clinical and renal histopathologic data in 77 patients with kidney failure admitted to the Department of Nephrology,the First Affiliated Hospital of Zhengzhou University were collected between December 2014 to April 2016.Twelve healthy people admitted to this hospital were selected as the control group.The clinical data of the renal failure group and the control group were collected,and the pathological data of the renal failure group were collected.Katafuchi score standard was used for semi quantitative score of glomerular sclerosis,interstitial inflammatory cell infiltration,interstitial fibrosis and tubular atrophy,and the expression level of uAGT was assessed by Enzyme-linked Immunosorbent Assay(ELISA).The correlation between uAGT and clinical and pathological data was analysed.The receiver operating characteristic(ROC)curve of uAGT for the diagnosis of renal pathological damage was drawn and the area under the ROC curve(AUC)was calculated.Results The levels of hemoglobin(Hb),serum albumin(Alb),estimated glomerular filtration rate(eGFR),and high density lipoprotein(HDL)in kidney failure group were lower than those in the control group,while levels of urea,uric acid(UA),creatinine(Cr),total cholesterol(TC),triacylglycerol(TG),uAGT in kidney failure group were higher than those in the control group(P<0.05).There was a negative correlation between uAGT and Hb,Alb,urea,eGFR(rs=-0.427,-0.379,-0.266,-0.254,all P<0.05),and a positive correlation between uAGT and urinary protein in patients with kidney failure(rs=0.445,P<0.001).There was a postive correlation between uAGT and glomerular sclerosis(rs=0.270,P=0.018),interstitial inflammatory cell infiltration(rs=0.401,P<0.001),interstitial fibrosis(rs=0.273,P=0.016)and tubular atrophy(rs=0.272,P=0.017),respectively.For diagnosing glomerular sclerosis,greater accuracy,interstitial fibrosis,and tubular atrophy,the AUC of the uAGT level was 0.627,0.689,0.627,0.639.Conclusions UAGT increased significantly in patients with renal failure,and the uAGT showed a positive correlation with interstitial inflammatory cell infiltration and can reflected its severity.uAGT level was able to identify interstitial inflammatory cell infiltration with greater accuracy,and may be used as a non-invasive biomarker of interstitial inflammatory cell infiltration in patients with kidney failure.