UMCP-1和UEGF预测原发性肾病综合征患儿肾小球滤过率的价值

Value of urinary monocyte chemoattractant protein-1 and urinary epidermal growth factor in predicting glomerular

目的按探讨尿单核细胞趋化蛋白-1(UMCP-1)和尿表皮生长因子(UEGF)预测原发性肾病综合征(PNS)患儿肾小球滤过率(eGFR)的价值。方法选取2016年3月至2018年3月在海南西部中心医院收治的85例PNS患儿,根据每年eGFR下降≥5%为标准将患儿分为肾快速进展组(30例)和肾非快速进展组(55例)。采用ELISA法测定UMCP-1和UEGF水平及生化法测定肌酐、白蛋白浓度,并计算eCFR。结果与肾非快速进展组相比,肾快速进展组患儿的UEGF/肌酐和UEGF/UMCP-1均显著降低,而UMCP-1/肌酐显著增加(均P<0.001)。相关性分析结果显示,UMCP-1与eGFR呈负相关(r=-0.29,P=0.008);UECF与eGFR呈正相关(r=0.39,P<0.001),与蛋白尿呈负相关(r=-0.59,P<0.001);UEGF/MCP-1比值与eGFR呈中度相关(r=0.63,P<0.001),与蛋白尿呈负相关(r=-0.34,P<0.001)。受试者工作特征(ROC)曲线分析结果显示UMCP-1、UECF、UEGF/MCP-1的曲线下面积(AUC)分别为0.68(95%CI:0.57~0.80),0.76(95%CI:0.62~0.84)和0.86(95%CI:0.75~0.93)。Kaplan-Meier生存曲线结果显示,高UMCP-1、低UEGF或UEGF/MCP-1能使患儿加快进展至肾终点(均P<0.001)。在多因素分析结果中,局灶节段性肾小球硬化、UEGF和UECF/MCP-1比值与eGFR快速下降显著相关。结论UMCP-1、UEGF和UECF/UMCP-1是PNS患儿肾脏疾病进展评估的指标,UECF和UECF/UMCP-1降低是eGFR下降的独立预测因子,可能有助于PNS患儿肾脏疾病的评估。

Objective To investigate the predictive value of the baseline level of urinary monocyte chemoattractant protein-1(UMCP-1)and epidermal growth factor-1(UEGF)at baseline and their ratio on the decline of glomerular filtration rate(eGFR)in children with primary nephrotic syndrome(PNS).Methods A total of 85 children with PNS admitted to Hainan West Central Hospital from March 2016 to March 2018 were selected and divided into a renal rapid progression group(30 cases)and a renal non-rapid progression group(55 cases)according to the annual eGFR decline of≥5%.The levels of UMCP-1 and UEGF were determined by ELISA,creatinine and albumin were determined by biochemical method,and eGFR was calculated.Results Both UEGF/creatinine and UEGF/UMCP-1 were significantly decreased and UMCP-1/creatinine were significantly increased in children with rapid renal progression compared with those with non-rapid renal progression(all P<0.001).Correlation analysis showed that UMCP-1 was negatively correlated with eGFR(r=-0.29,P=0.008).UEGF was positively correlated with eGFR(r=0.39,P<0.001),and negatively correlated with albuminuria(r=-0.59,P<0.001).The UECF/MCP-1 ratio was moderately associated with eGFR(r=0.63,P<0.001)and negatively associated with proteinuria(r=-0.34,P<0.001).Receiver operating characteristic(ROC)curve analysis results showed that the area under the curve(AUC)of UMCP-1,UECF and UECF/MCP-1 were 0.68(95%CI:0.57-0.80),0.76(95%CI:0.62-0.84)and 0.86(95%CI:0.75-0.93),respectively.Kaplan-Meier survival curve results showed that high UMCP-1,low UEGF or UEGF/MCP-1 accelerated progression to the renal endpoint(all P<0.001).In the results of multivariate analysis,focal segmental glomerulosclerosis,UEGF and UECF/MCP-1 ratio were significantly associated with rapid eGFR decline.Conclusions UMCP-1,UECF and UECF/UMCP-1 ratio are promising markers of renal progression among PNS children.The decrease of UECF and UEGF/UMCP-1 ratio are independent predictors of the decrease of eGFR after adjustments for conventional markers,which may be helpful for the assessment of renal disease in children with PNS.