本文選題：小兒原發(fā)性腎病綜合征 + 中性粒細(xì)胞明膠酶相關(guān)脂質(zhì)運(yùn)載蛋白　； 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:應(yīng)用益腎活血中藥腎康靈干預(yù)兒童頻復(fù)發(fā)性腎病(frequent relapse nephrotic syndrome,FRNS),通過(guò)觀察FRNS患兒治療前后尿中性粒細(xì)胞明膠酶相關(guān)性脂質(zhì)運(yùn)載蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、腎損傷分子 1(kidney injury molecule 1,KIM-1)、白細(xì)胞介素18(interleukin 18,IL-18)等變化,進(jìn)一步闡明小兒FRNS的發(fā)病機(jī)制及益腎活血中藥腎康靈干預(yù)小兒FRNS的作用機(jī)制,尋找腎臟早期損害的生物學(xué)標(biāo)記物,以提高FRNS的臨床療效。方法:選自2016年1月至2016年12月期間福建中醫(yī)藥大學(xué)附屬人民醫(yī)院及福州軍區(qū)總醫(yī)院門診和住院FRNS(單純型、頻復(fù)發(fā))患兒40例,采用隨機(jī)數(shù)字表法分為中西醫(yī)結(jié)合治療組20例(A組)和西藥對(duì)照組20例(B組),從體檢中心抽取健康兒童20例作為健康對(duì)照組(C組)。觀察兩組治療前和治療4周后、12周后的尿NGAL、KIM-1、IL-18變化。應(yīng)用SPSS20.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理。結(jié)果:1.治療前比較,A、B兩組的尿NGAL、KIM-1、IL-18水平明顯高于C組(P均0.01),而AB兩組間的尿NGAL、KIM-1、IL-18、α1微球蛋白水平和血清蛋白、膽固醇、甘油三酯、肌酐水平比較無(wú)顯著差異(P均0.05)。2.治療4周后,與治療前比較A、B兩組尿的NGAL、KIM-1、IL-18、α1微球蛋白水平明顯降低(P均0.01),血清白蛋白明顯升高(P0.01),血肌酐無(wú)顯著變化(P均0.05),血清膽固醇、甘油三酯A組降低(P0.01和P0.05),而B(niǎo)組無(wú)顯著差異(P0.05);A組與B組比較,A組的尿KIM-1水平明顯低于B組(P0.01),尿NGAL水平明顯高于B組(P0.01),尿IL-18、α1微球蛋白水平A、B兩組比較無(wú)顯著差異(P均0.05),膽固醇、甘油三酯水平A組明顯低于B組(P均0.05),血清蛋白水平A組明顯高于B組(P0.05),血肌酐A、B兩組間無(wú)顯著差異(P0.05)。3.治療12周后,與治療前比較A、B兩組尿NGAL、KIM-1、IL-18、α1微球蛋白、血清膽固醇、甘油三酯水平明顯降低(P均0.01),血清白蛋白明顯升高(P均0.01),血肌酐無(wú)顯著變化(P均0.05);與治療4周后比較,尿NGAL水平A組明顯降低(P0.01),而B(niǎo)組比較無(wú)顯著差異(P0.05),尿KIM-1、IL-18、α1微球蛋白、血清膽固醇、甘油三酯水平明顯降低(P0.01,P0.01,P0.01,P0.05,P0.05),血清白蛋白明顯升高(P0.01),血肌酐無(wú)顯著變化(P0.05);A組與B組比較,尿NGAL、KIM-1、IL-18、α1微球蛋白、血肌酐水平無(wú)顯著差異(P均0.05),血清蛋白水平A組明顯高于B組(P0.05),膽固醇、甘油三酯水平A組明顯低于B組(P0.05和P0.01)。尿NGAL、KIM-1、IL-18的ROC曲線下面積分別為0.893、0.886、0.837,最佳臨界點(diǎn)分別為 84.78ng/ml、8.01ng/ml、212.56pg/ml,敏感性分別為 87%、74%、87%,特異性分別為 82%、91%、73%。結(jié)論:①FRNS患兒存在著尿NGAL、KIM-1、IL-18水平的異常升高,提示NGAL、KIM-1、IL-18參與了 FRNS的發(fā)病機(jī)制。②應(yīng)用益腎活血中藥腎康靈治療后KIM-1下降明顯,治療4周后治療組指標(biāo)水平低于對(duì)照組,中藥腎康靈可能對(duì)降低患兒尿NGAL、IL-18水平有一定作用,中藥結(jié)合西藥治療,可能有助于減輕腎小管損傷的程度。③中西醫(yī)結(jié)合治療在提高血清白蛋白,降低膽固醇、甘油三酯等療效方面優(yōu)于單純西藥組,中藥腎康靈能通過(guò)改善體內(nèi)高凝、高脂狀態(tài),提高臨床療效。④尿NGAL、KIM-1、IL-18較血肌酐變化更敏感,在血肌酐未發(fā)生改變之前尿NGAL、KIM-1、IL-18就發(fā)生改變,因此,尿NGAL、KIM-1、IL-18可作為腎小管早期損害的特異性生物學(xué)標(biāo)記物,為FRNS的臨床治療和預(yù)后判斷提供客觀指標(biāo)。
[Abstract]:Objective: to use Yishen and blood activating medicine Shen Kang Ling to interfere with Frequent Relapse Nephrotic Syndrome (FRNS), and to observe the urinary neutrophil gelatinase related lipid carrier protein (neutrophil gelatinase-associated lipocalin, NGAL), kidney injury molecule 1 (kidney injury) 1, before and after treatment of children with FRNS. ), the changes of interleukin 18 (interleukin 18, IL-18) and so on, further elucidate the pathogenesis of FRNS in children and the mechanism of Shen Kang Ling to intervene in children's FRNS, look for the biological markers of early renal damage to improve the clinical efficacy of FRNS. Methods: from January 2016 to December 2016, the Fujian University of traditional Chinese medicine was attached. 40 cases of FRNS (Dan Chunxing, frequency recurrent) children in the people's Hospital and the General Hospital of the Fuzhou military area general hospital were divided into 20 cases (group A) and 20 cases (group B) with western medicine combined treatment group and Western medicine control group. 20 healthy children were selected from the medical center as the healthy control group (group C). The two groups were observed before and after 4 weeks of treatment and 12 weeks later. The urine NGAL, KIM-1, IL-18 changes. The results were as follows: 1. before treatment, the levels of NGAL, KIM-1, IL-18 in group A and B two were significantly higher than those of C group (P 0.01), while there was no significant difference in the level of alpha 1 microglobulin and serum protein, cholesterol, triglyceride and creatinine in the two groups of AB (0.05 After 4 weeks of.2. treatment, compared with before treatment, the levels of NGAL, KIM-1, IL-18, and alpha 1 microglobulin in the urine of B two were significantly decreased (P 0.01), serum albumin increased significantly (P0.01), serum creatinine was not significantly changed (P 0.05), serum cholesterol and triglyceride A group decreased (P0.01 and P0.05), but there was no significant difference in the group (P0.01 and P0.05). The level of urine NGAL was significantly lower than that of group B (P0.01), the level of urine NGAL was higher than that of group B (P0.01), the level of IL-18, alpha 1 microglobulin level A, B two group was no significant difference (P 0.05), the cholesterol and triglyceride level in A group was significantly lower than that of B group (P all 0.05), serum creatinine levels were significantly higher than those of the group two. After the week, the urine NGAL, KIM-1, IL-18, alpha 1 microglobulin, serum cholesterol and triglyceride levels were significantly decreased (P 0.01), serum albumin was significantly increased (P 0.01), serum creatinine was not significantly changed (P 0.05) in the two groups of B two, and the serum albumin was significantly lower (P0.01) compared with the 4 weeks after treatment (P0.01), but there was no significant difference between the B group and the urine. KIM-1, IL-18, alpha 1 microglobulin, serum cholesterol and triglyceride levels decreased significantly (P0.01, P0.01, P0.01, P0.05, P0.05), serum albumin increased significantly (P0.01), and serum creatinine was not significantly changed (P0.05). There was no significant difference between A and B group. There was no significant difference in the level of urinary NGAL, 1 microglobulin and serum creatinine (0.05), and the serum albumin level was significantly higher. In group B (P0.05), the level of cholesterol and triglyceride level in A group was significantly lower than that in group B (P0.05 and P0.01). The area under the ROC curve of NGAL, KIM-1 and IL-18 was 0.893,0.886,0.837, and the best critical point was 84.78ng/ml, respectively, and the sensitivity was 87%, 74%, 87% respectively, and the specificity was 82%, 91% respectively. The abnormal elevation of GAL, KIM-1 and IL-18 levels suggested that NGAL, KIM-1 and IL-18 were involved in the pathogenesis of FRNS. (2) the decrease of KIM-1 in the treatment group was obviously lower after the treatment of Yishen Huoxue Chinese medicine Shen Kang Ling. After 4 weeks of treatment, the index level of the treatment group was lower than that of the control group. The combination of Chinese and Western medicine is better than the western medicine group in improving serum albumin, lowering cholesterol and triglyceride. The Chinese medicine Shen Kang Ling can improve the body hypercoagulability, high fat state and improve the clinical effect. 4. The urine NGAL, KIM-1, IL-18 are more sensitive than the blood creatinine, and in the blood creatinine The urine NGAL, KIM-1, and IL-18 changes before the changes. Therefore, urine NGAL, KIM-1, and IL-18 can be used as specific biomarkers for the early damage of renal tubules, providing an objective indicator for the clinical treatment and prognosis of FRNS.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R272

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