原发性肾病综合征中性粒细胞明胶酶相关脂质转运蛋白的表达及临床意义

Expression and Significance of Neutrophil Gelatinase-associated Lipocalin in Patients with Nephrotic Sydrome

目的通过检测原发性肾病综合征(PNS)患者血、尿中性粒细胞明胶酶相关脂质转运蛋白(NGAL),分析其与病理类型及临床指标的关系。方法方便选取2015—2018年该院50例PNS患者,根据肾活检病理结果分组,根据有无急性肾小管坏死(ATN)分急性肾损伤(AKI)组及非AKI组,25名例健康体检者作为正常对照组检测血、尿NGAL浓度,观察NGAL在NS不同病理类型的表达水平;同时检测血白蛋白、血肌酐、24 h尿蛋白定量等临床指标。观察NGAL的变化及与临床指标的关系。结果AKI组患者血、尿NGAL水平[(176.75±57.31)ng/mL,(241.72±78.49)ng/mL]高于非AKI组[(132.78±55.69)ng/mL,(189.36±60.10)ng/mL]及对照组[(83.41±23.45)ng/mL,(38.73±24.58)ng/mL](t=2.085,2.328,6.305,11.379,P=0.043,0.025,0.000,0.000);病理类型不同,血、尿NGAL表达水平不同:其中膜性肾病组[(169.98±50.04)ng/mL,(220.84±67.24)ng/mL]及局灶节段硬化组[(289.8±94.58)ng/mL,(296.14±76.22)ng/mL]较微小病变组NGAL水平[(116.63±48.55)ng/mL,(173.68±63.24)ng/mL]升高(t=3.364,3.042,6.085,4.051,P=0.004,0.048,0.000,0.001)。血、尿NGAL与24 h尿蛋白定量、血尿素氮和血肌酐呈正相关(r=0.274、0.288;0.113、0.129;0.310、0.525,P<0.05),与血白蛋白呈负相关(r=-0.255,-0.733,P<0.05)。结论血、尿NGAL可能作为早期判断PNS并发急性肾损伤的敏感、无创指标,一定程度下可预测病理类型。

Objective To detect the significance of Neutrophil gelatinase associated lipocalin(NGAL)level of the patients with primary nephrotic syndrome(PNS)and the correlation with the renal pathological type and the clinical indicators.Methods Convenient selected fifty PNS patients who were in the hospital from 2015 to 2018 were selected in the study and divided according to the pathological results.Serum samples from 25 healthy persons was used as controls.The levels of NGAL were detected by ELISA.At the same time,albumin,serum creatinine and 24-hour urine protein were measured.The changes of NGAL and its relationship with serum creatinine,urine protein were observed.Results The blood and urine NGAL levels[(176.75±57.31)ng/mL,(241.72±78.49)ng/mL]in the AKI group were higher than those in the non-AKI group[(132.78±55.69)ng/mL,(189.36±60.10)ng/mL]and the control group[(83.41±23.45)ng/mL,(38.73±24.58)ng/mL]the difference was statistically significant(t=2.085,2.328,6.305,11.379,P=0.043,0.025,0.000,0.000);different pathological types,different levels of blood and urine NGAL expression:membranous nephropathy group[(169.98±50.04)ng/mL,(220.84±67.24)ng/mL]and focal segmental sclerosis group[(289.8±94.58)ng/mL,(296.14±76.22)ng/mL]compared with NGAL level in the minimal lesion group[(116.63±48.55)ng/mL,(173.68±63.24)ng/mL]increased the difference was statistically significant(t=3.364,3.042,6.085,4.051,P=0.004,0.048,0.000,0.001).Blood and urine NGAL were positively correlated with 24 h urine protein quantitation,blood urea nitrogen and serum creatinine(r=0.274,0.288,0.113,0.129;0.310,0.525,P<0.05),and negative with albumin.Correlation(r=-0.255,-0.733,P<0.05).Conclusion The level of NGAL can be used as one of the sensitive indexes for early and non-invasive detection ofPNS with AKI.