尿肾损伤分子-1在IgA肾病临床评估中的意义

Significance of urine kidney injury molecule-1 in evaluating IgA nephropathy

目的探究尿肾损伤分子-1(kidney injury molecule-1,KIM-1)在IgA肾病患者临床评估中的意义。方法选取2016年1月至2018年1月本院102例IgA肾病患者和50例健康体检者为研究对象,将IgA肾病患者纳入观察组,将健康体检者纳入对照组,分析两组研究对象的临床基线资料,检测并比较两组研究对象尿KIM-1水平,进一步分析尿KIM-1与IgA肾病临床及病理特征的相关性。结果观察组患者血清白蛋白水平和估算肾小球滤过率(estimated glomerular filtration rate,eGFR)均显著低于对照组(均P < 0.05),平均动脉压、血清肌酐和血清胆固醇水平均显著高于对照组(均P < 0.05)。IgA肾病患者尿KIM-1水平与血清肌酐水平和24 h蛋白尿定量均呈正相关(r = 0.58,P < 0.001;r = 0.65,P < 0.001),与eGFR呈负相关(r =-0.56,P < 0.001)。不同Lee分级IgA肾病患者尿KIM-1水平均显著高于对照组(均P < 0.05)。Lee分级与IgA肾病患者尿KIM-1水平呈正相关(r = 0.76,P < 0.001),肾小管损伤间质纤维化程度与IgA肾病患者尿KIM-1水平呈正相关(r =0.78,P < 0.001)。IgA肾病患者病理组织中KIM-1高表达,肾组织KIM-1评分与尿KIM-1水平呈正相关(r = 0.73,P = 0.03)。结论 IgA肾病患者尿KIM-1水平明显升高,尿KIM-1是评价IgA肾病严重程度的有效指标。

Objective To investigate the significance of urine kidney injury molecule-1 (KIM-1) in assessing IgA nephropathy. Method From January 2016 to January 2018, 102 patients with IgA nephropathy and 50 healthy people in our hospital were selected as subjects, patients with IgA nephropathy were included in observation group and healthy people were included in control group. Clinical baseline data of the two groups were analyzed, the urine KIM-1 levels of the two groups were detected and compared, and the correlation between urine KIM-1 and clinical and pathological features of IgA nephropathy was analyzed. Result The serum albumin level and estimated glomerular filtration rate (eGFR) in observation group were significantly lower than those in control group (all P < 0.05), and the mean arterial pressure, serum creatinine and serum cholesterol levels were significantly higher than those in control group (all P < 0.05). The level of urine KIM-1 was positively correlated with the level of serum creatinine and 24 h albuminuria in patients with IgA nephropathy (r=0.58, P<0.001;r=0.65, P<0.001), and negatively correlated with eGFR (r=-0.56, P<0.001). The level of urine KIM-1 in patients with IgA nephropathy with different Lee classification was significantly higher than that in control group (all P < 0.05). Lee classification was positively correlated with the level of urine KIM-1 in patients with IgA nephropathy (r = 0.76, P < 0.001). The degree of interstitial fibrosis in patients with renal tubular injury was positively correlated with the level of urine KIM-1 in patients with IgA nephropathy (r = 0.78, P < 0.001). The expression of KIM-1 was high in the pathological tissues of patients with IgA nephropathy, and the KIM-1 score in renal tissue was positively correlated with the level of urine KIM-1 (r = 0.73, P = 0.03). Conclusion The level of urine KIM-1 in patients with IgA nephropathy is significantly higher, and it is an effective index to evaluate the severity of IgA nephropathy.