原发性肾病综合征患儿血清sTREM-1、suPAR的表达及临床意义

Expression and clinical significance of serum sTREM-1 and suPAR in children with primary nephrotic syndrome

目的探究原发性肾病综合征(PNS)患儿血清中可溶性髓样细胞触发受体-1(sTrem-1)、可溶性尿激酶型纤溶酶原激活物受体(suPAR)的表达水平变化及临床意义。方法选取2016年5月至2018年11月间在空军军医大学附属西京医院住院治疗的初诊PNS患儿78例(病例组)和同期选取的40例健康儿童(对照组)作为研究对象。病例组患儿依据病理学特征分为局灶性节段性肾小球硬化(20例)、膜性肾病(15例)、系膜增生性肾小球肾炎(25例)、膜增生性肾小球肾炎(6例)及微小病变型(12例);根据是否存在急性肾小管坏死分为急性肾损伤组(23例)和非急性肾损伤组(55例)。比较病例组与对照组儿童的临床资料及其血清中的sTREM-1、suPAR水平,比较急性肾损伤组和非急性肾损伤组患儿血清中的sTREM-1、suPAR水平,以及不同病理学类型患儿血清中sTREM-1、suPAR水平,并分析血清中sTREM-1、suPAR水平与其它临床指标的相关性。结果病例组患儿的三酰甘油(TG)、总胆固醇(TC)、血清白蛋白(ALB)、尿蛋白(Up)、尿酸(UA)、尿肌酐(Ucr)、尿N-乙酰-β-氨基葡萄糖苷酶(NAG)及尿微球蛋白(β2-MG)、髓样细胞触发受体-1(sTREM-1)、可溶性尿激酶型纤溶酶原激活物受体(suPAR)分别与对照组比较差异均有统计学意义(P>0.05);急性肾损伤组患儿的sTREM-1、suPAR水平分别为(108.57±23.75)ng/L、(186.53±34.39)ng/L,明显高于非急性肾损伤组的(56.24±13.42)ng/L、(78.17±30.21)ng/L,也明显高于对照组的(26.41±8.24)ng/L、(32.43±12.09)ng/L,差异均有统计学意义(P<0.05),非急性肾损伤组与对照组比较,差异有统计学意义(P<0.05);不同病理学特征患儿的sTREM-1、suPAR指标经单因素方差分析,其差异有统计学意义(P<0.05);Pearson相关性分析结果显示,血清中的sTREM-1、suPAR水平与TG、TC、UP/Ucr、尿NAG和β2-MG水平呈正相关(0.449、0.548、0.584、0.216、0.119;0.507、0.573、0.703、0.407、0.493,P<0.05),与ALB呈负相关(0.519、-0.643,P<0.05)。结论PNS患儿血清中sTREM-1、suPAR水平显著升高,且在急性肾损伤与部分病理类型中更为明显,可以为PNS患儿的病情评估提供一定临床参考价值。

Objective To investigate the change of expression levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and soluble urokinase-type plasminogen activator receptor (suPAR) in serum of children with primary nephrotic syndrome (PNS) and its clinical significance. Methods From May 2016 to November 2018, 78 cases (case group) of newly diagnosed PNS who were hospitalized in Xijing Hospital of Air Force Medical University and 40 healthy children (control group) selected in the same period were enrolled in this study. According to the pathological characteristics, children in the case group were divided into focal segmental glomerulosclerosis (20 cases), membranous nephropathy (15 cases), mesangial proliferative glomerulonephritis (25 cases), membranoproliferative glomerulonephritis (6 cases), and micropathological changes (12 cases);and these pediatric patients were divided into acute renal injury group (23 cases) and non-acute renal injury group (55 cases) according to the presence or absence of acute tubular necrosis. The clinical data of children and their serum levels of sTREM-1, suPAR were compared between the case group and the control group. The serum levels of sTREM-1 and suPAR were compared between the acute renal injury group and the non-acute renal injury group, as well as between children with different pathological changes;then the correlation was analyzed between serum levels of sTREM-1, suPAR and other clinical indexes. Results The serum levels of triacylglycerol (TG), total cholesterol (TC), serum albumin (ALB), urine protein (UP), uric acid (UA), urine creatine (Ucr), urinary N-acetyl-β-D-glucosaminidase (NAG), urinary β2-microglobulin (β2-MG), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), and soluble urokinase-type plasminogen activator receptor (suPAR) in the case group were significantly different from those in the control group, and all differences were statistically significant (P> 0.05). The levels of sTREM-1 and suPAR in the acute kidney injury group was respectively (108.57±23.75) ng/L and (186.53±34.39) ng/L, which was significantly higher than corresponding (56.24±13.42) ng/L and (78.17±30.21) ng/L in the non-acute renal injury group;and the levels were also significantly higher than corresponding (26.41±8.24) ng/L and (32.43±12.09) ng/L in the control group, and all differences were statistically significant (P<0.05). In addition, there was significant difference between the non-acute renal injury group and the control group (P<0.05). The sTREM-1 and su- PAR indicators in children with different pathological changes were analyzed by univariate analysis of variance, and the differences were statistically significant (P<0.05). The results of Pearson correlation analysis showed that the serum levels of sTREM-1 and suPAR were positively correlated with the levels of TG (r=0.449 and r=0.507, respectively), TC (0.548 and 0.573), UP/Ucr (0.584 and 0.703), urinary NAG (0.216 and 0.407),β2-MG (0.119 and 0.493), and negatively correlated with ALB (r=0.519 and -0.643, respectively);all differences were statistically significant (P<0.05). Conclusion The serum levels of sTREM-1 and suPAR are significantly elevated in children with PNS, which is more obvious in acute renal injury and certain pathological changes. This may provide certain clinical reference for the evaluation of children with PNS.