尿转铁蛋白在诊断风湿病患者早期肾损害中的应用研究

Application Study of Urinary Transferrin in the Diagnosis of Early Renal Damage in Patients with Rheumatism

目的尿转铁蛋白是反映肾小球滤膜损伤的灵敏指标,该文旨在探讨尿微量蛋白在风湿病患者早期肾损害中的诊断意义。方法对2005年1月—2010年9月北京积水潭医院风湿免疫科门诊和住院的631例风湿病患者尿液中微量蛋白进行检测。结果与非SLE患者相比,SLE患者尿中MA(P<0.01)、TRF(P<0.0001)、IgG(P<0.05)增高例数百分比显著升高,两组比较α1-MG、NAG差异无统计学意义(P>0.05)。SLE患者尿中MA(P<0.05)、TRF(P<0.0001)水平较非SLE患者显著升高,两组患者尿中α1-MG、IgG、NAG水平比较差异无统计学意义(P>0.05)。与不伴肾损伤SLE患者组相比,伴肾损伤组SLE患者组尿中MA、α1-MG、TRF、IgG水平均升高(P<0.05)。两组患者尿中NAG水平相比差异无统计学意义(P>0.05)。相关性分析显示,SLE患者尿微量蛋白之间均呈正相关(P<0.05)。SLE患者尿中MA、TRF、IgG与肾损伤指标——尿蛋白、尿红细胞及管型均呈正相关(P<0.05)。与疾病活动指标的相关性分析显示,SLE患者尿中TRF水平与ESR(r=0.389)呈正相关(P<0.05)。尿中IgG水平与ESR(r=0.602)呈正相关(P<0.05),与补体C3(r=-0.317,P<0.05)呈负相关。其余相关性无统计学意义(P>0.05)。结论与其他风湿病相比,由于TRF分子量小、所带负电荷少,且检测具有简便、快速、有效和无创伤性,在SLE患者早期肾损伤的诊断中具有广阔的临床应用前景。

Objective Urinary transferrin is a sensitive indicator reflecting glomerular membrane damage.This article aims to explore the diagnostic significance of urinary microproteins in early renal damage in rheumatic patients.Methods The trace protein in urine of 631 rheumatic patients in the outpatient and inpatient department of rheumatology and immunology in Beijing Jishuitan Hospital from January 2005 to September 2010 was detected.Results Compared with non-SLE patients,the percentage of cases with increased urine MA(P<0.01),TRF(P<0.0001),IgG(P<0.05)in SLE patients was significantly increased,and there was no statistically significant difference inα1-MG and NAG between the two groups difference(P>0.05).The urine MA(P<0.05)and TRF(P<0.0001)levels in SLE patients were significantly higher than those in non-SLE patients.There was no significant difference in urineα1-MG,IgG and NAG levels between the two groups(P>0.05).Compared with the SLE patient group without kidney injury,the urine MA,α1-MG,TRF and IgG levels in the SLE patient group with kidney injury group were increased(P<0.05).There was no statistically significant difference in urine NAG levels between the two groups(P>0.05).Correlation analysis showed that there was a positive correlation between urine microproteins in patients with SLE(P<0.05).Urine MA,TRF and IgG in SLE patients were positively correlated with indicators of kidney damage-urine protein,urine red blood cells and cast(P<0.05).Correlation analysis with disease activity indicators showed that urine TRF levels in SLE patients were positively correlated with ESR(r=0.389,P<0.05).Urine IgG levels were positively correlated with ESR(r=0.602,P<0.05),and negatively correlated with complement C3(r=-0.317,P<0.05)(Figure 4).The correlation analysis was not statistically significant(P>0.05).Conclusion Compared with other rheumatic diseases,TRF has small molecular weight,less negative charge,and simple,rapid,effective and non-invasive detection.It has broad clinical application prospects in the diagnosis of early renal injury in SLE patients.