成人原发性肾病综合征患者尿NGAL、α1-MG水平与疾病预后的关系探讨

Relationship between urinary NGAL, α1-MG levels and disease prognosis in adult patients with primary nephrotic syndrome

目的探讨成人原发性肾病综合征患者尿中性粒细胞明胶酶相关脂质运载蛋白(neutrophilic gelatase-associated lipocalin, NGAL)、α1-微球蛋白(α1-microglobulin,α1-MG)水平与疾病预后的关系。方法选取本院2015年12月~2020年2月70例原发性肾脏疾病患者作为疾病组,同期纳入70例健康志愿者为健康组。疾病组给予环磷酰胺联合糖皮质激素进行治疗,并对患者入院时的24 h尿蛋白、血肌酐(SCr)、尿素氮(BUN)、NGAL、α1-MG水平进行检测。比较不同预后患者NGAL、α1-MG水平。结果疾病组24 h尿蛋白、SCr、BUN、NGAL及α1-MG水平均高于健康组(P<0.05);经Pearson相关性分析:疾病组患者尿NGAL及α1-MG分别与24 h尿蛋白、SCr、BUN呈正相关(P<0.05);复发患者治疗前及治疗后尿NGAL、α1-MG水平均高于未复发患者(P<0.05)。经预后诊断效能ROC曲线分析发现,治疗后尿NGAL曲线下面积(AUC=0.844)大于治疗前尿NGAL曲线下面积(AUC=0.746),治疗后α1-MG曲线下面积(AUC=0.810)大于治疗前α1-MG曲线下面积(AUC=0.723)。结论原发性肾病综合征患者尿NGAL、α1-MG水平均升高,高水平的尿NGAL、α1-MG与原发性肾病综合征患者更差的预后有关。

Objective To investigate the relationship between urinary neutrophil gelatase-associated lipid(NGAL) and α1-microglobulin(α1-MG) levels and disease prognosis in adult patients with primary nephrotic syndrome. Methods A total of 70 patients with primary kidney disease admitted to our hospital from December 2015 to February 2020 were selected as the disease group, and 70 healthy volunteers were included as the healthy group during the same period. Patients in the disease group were treated with cyclophosphaamide combined with glucossebum hormone progression therapy, and 24 h urinary protein, serum creatinine(SCr), urea nitrogen(BUN), NGAL, α1-Mg levels were detected at admission and 6 months after treatment. The levels of NGAL and α1-MG in patients with different prognosis were compared. Results The 24 h urinary protein, SCr, BUN, NGAL and α1-Mg levels in disease group were higher than those in healthy group(P<0.05). Pearson correlation analysis showed that urinary NGAL and α1-MG were positively correlated with 24 h urinary protein, SCr and BUN in disease group(P<0.05). The levels of NGAL and α1-MG in patients with recurrence before and after treatment were higher than those in patients without recurrence(P<0.05). After treatment, the area under the NGAL curve(AUC=0.844) was greater than that before treatment(AUC=0.746), and the area under the α1-MG curve after treatment(AUC=0.810) was greater than that before treatment(AUC=0.723). Conclusion Urinary NGAL and α1-MG levels are elevated in patients with primary nephrotic syndrome, and higher levels of NGAL and α1-MG are associated with a worse prognosis in patients with primary nephrotic syndrome.