尿中性肽链内切酶:一种新的肾小管损伤指标

Urinary Neutral Endopeptidase:a New Marker for Renal Tubular Injury

目的:建立尿中性肽链内切酶(NEP)检测方法,并应用于肾小管损伤的判断。方法:应用三明治ELISA法和荧光法检测尿NEP,对两种方法的检测效果予以评价,并比较两种方法在帮助诊断肾小管疾病中的符合率及差异性。对各种肾脏疾病患者与正常对照组尿NEP进行比较,并在各组内对尿NEP与其他代表肾小管损伤的指标进行比较。结果:两者符合率大致相等,在各组中两种方法检测结果的差异无显著性。在急性肾小管损伤组中,尿NEP明显高于正常对照组;在慢性肾小管损伤组、马兜铃酸肾病组、慢性肾功能衰竭组,尿NEP均明显低于正常对照组,且尿NEP与尿微量蛋白呈不同程度的负相关;在单纯肾小球疾病组,尿NEP与正常对照组差异无显著性,与尿微量蛋白不相关。结论:尿NEP在肾脏疾病的不同病程中出现双向的变化,当结合其他尿微量蛋白检测时,可以帮助判断肾小管损伤处于急性期还是慢性期,从而有助于选择治疗方案和评估预后。

Objective:To establish methods of measuring urinary neutral endopeptidase(NEP)and to judge the renal tu bular injury.Methods:Sandwich ELISA and two-step fluorimetric assay were used t o determine the urinary NEP.The accuracy and repeatability of both methods were investigated.Urinary excretion of NEP was detected in149hospitalized patients wi th different kinds of renal diseases and normal controls and the results were co mpared with other markers of tubular injury.Results:There were no significant di fferences of urinary NEP levels defermined by the two assays between patients wi th renal diseases and between normal controls.But the level in patients with acu te tubular injury was much higher than that of normal control group,while those with chronic tubular injury,Aristolochic acid nephropathy or chronic renal failu re were much lower.Moreover,NEP enzymuria positively correlated with individual creatinine clearance values and negatively correlated with urinary micro-protei ns levels.Conclusion:Urinary NEP changes in different processes of renal tubular injury,and it may be useful for estimating the acute tubular injury or chronic tubular injury together with other tubular markers.