肾病综合征患儿血清ET-1、SDC-1水平及其与激素治疗反应的相关性研究

Serum levels of ET-1 and SDC-1 in children with nephrotic syndrome and their correlation with hormone therapy response

目的 探讨血清内皮素-1(ET-1)、多配体蛋白聚糖-1(SDC-1)水平与肾病综合征(NS)患儿对激素治疗反应性的相关性。方法 选取拟行激素治疗的157例NS患儿和同期67例与NS患儿年龄和性别匹配的健康儿童(对照组)。收集临床资料,检测血清ET-1、SDC-1、24 h尿蛋白、尿素氮(BUN)、血肌酐(Scr)等实验室指标。根据NS患儿对激素治疗的反应性,将其分为激素抵抗型肾病综合征(SRNS)组(31例)和激素敏感型肾病综合征(SSNS)组(126例)。采用Logistic回归分析NS患儿对激素治疗抵抗的影响因素,采用受试者工作特征(ROC)曲线分析ET-1、SDC-1对SRNS和SSNS的鉴别诊断价值。结果 对照组、SSNS组、SRNS组的体质量、BUN、Scr、24 h尿蛋白、ET-1和SDC-1水平依次升高,血白蛋白依次降低(P<0.05)。所有受试儿血清ET-1、SDC-1水平与BUN、Scr、24 h尿蛋白呈正相关,与血白蛋白水平呈负相关(P<0.05)。多因素Logistic回归分析结果显示,ET-1、SDC-1升高是NS患儿对激素治疗抵抗的危险因素(P<0.05)。ROC分析结果显示,联合ET-1、SDC-1鉴别SRNS和SSNS的曲线下面积为0.943,高于ET-1和SDC-1(Z分别为3.959和4.364,P<0.05)。结论 SRNS患儿血清ET-1和SDC-1水平升高,且与肾功能损伤以及对激素治疗抵抗有关,可作为SRNS和SSNS鉴别诊断的潜在指标。

Objective To investigate the correlation between serum levels of endothelin-1(ET-1)and polyligand proteoglynan-1(SDC-1)with the responsiveness to hormone therapy in children with nephrotic syndrome(NS).Methods A total of 157 children with NS who were expected to receive hormone therapy and 67 healthy children matching the age and sex with NS at the same time were selected(the control group).Clinical data were collected and serum levels of ET-1,SDC-1,24 h urine protein,urea nitrogen(BUN),serum creatinine(Scr)and other laboratory indexes were detected.According to the response to hormone therapy,NS children were divided into the hormone resistant nephrotic syndrome(SRNS)group(31 cases)and the hormone sensitive nephrotic syndrome(SSNS)group(126 cases).Factors influencing the resistance of NS children to hormone therapy were analyzed by Logistic regression,and the differential diagnositic value of ET-1 and SDC-1 to SRNS and SSNS were analyzed by receiver operating characteristic curve(ROC).Results The levels of body weight,BUN, Scr, 24 h urine protein, ET-1 and SDC-1 were increased successively in the control group, the SSNS group and theSRNS group, while the serum albumin was decreased successively (P<0.05). Serum ET-1 and SDC-1 levels of all thesubjects were positively correlated with BUN, Scr and 24 h urinary protein, and negatively correlated with serum albuminlevel (P<0.05). Multivariate Logistic regression analysis showed that the increased ET-1 and SDC-1 were risk factors forthe resistance of NS children to hormone therapy (P<0.05). ROC analysis results showed that the area under the curve forthe identification of SRNS and SSNS combined with ET-1 and SDC-1 was 0.943, which was higher than ET-1 and SDC-1(Z=3.959, 4.364, P<0.05). Conclusion Serum ET-1 and SDC-1 levels are significantly increased in children with SRNS,which are related to renal function injury and resistance to steroid therapy, and can be used as potential indicators for thedifferential diagnosis of SRNS.