本文選題：原發(fā)性腎病綜合征 + MCP-1��； 參考：《山西醫(yī)科大學》2012年碩士論文

【摘要】：目的： 檢測原發(fā)性腎病綜合征(PNS)患兒不同時間點尿液中單核細胞趨化蛋白-1(MCP-1)、白介素-18(IL-18)的含量,探討其與PNS的發(fā)生、發(fā)展、反復及預后有無相關(guān)性,尋找相對特異和敏感的生物學標記物為臨床治療原發(fā)性腎病綜合征及判斷其預后提供線索。 方法： 選取本院住院的65例PNS患兒為研究對象,根據(jù)對激素效應(yīng)及隨訪結(jié)果分為三組：激素敏感型腎病綜合征(SSNS)35例,激素耐藥型腎病綜合征(SRNS)15例,頻反復腎病綜合征(FRNS)15例。另取20例健康體檢兒童作為正常對照組。分別在三個時間點采集外周血標本及尿標本：第1時間點,發(fā)病初期未用糖皮質(zhì)激素(GC)時；第2時間點,足量GC治療8周時；第3時間點,GC治療16周或病情反復時。進行如下實驗①ELISA法檢測患兒不同時間點尿液中MCP-1及IL-18的水平②采用全自動生化分析儀測定PNS患兒不同時間點血尿素氮、肌酐及24小時尿蛋白定量。 結(jié)果： 1. SSNS組治療前、治療后8周尿MCP-1水平均高于正常對照組,差異無顯著性(P0.05)；但治療16周后顯著低于治療前、治療后8周及正常對照組(P0.05)。SRNS組治療前尿MCP-1水平顯著高于SSNS組治療前與對照組(P0.05),但與治療后8周比較無顯著差異(P0.05),當聯(lián)合免疫抑制劑環(huán)磷酰胺治療16周后則顯著低于治療前、治療后8周(P0.05)。分別對三個時間點SRNS組和SSNS組患兒尿MCP-1的水平進行比較,SRNS組均顯著高于SSNS組(P均0.05)。 2. FRNS組患兒治療前、治療后8周尿MCP-1水平與正常對照組,及SSNS組比較無顯著差異(P0.05),但顯著低于SRNS組(P0.05),當病情反復時,與治療前、治療后8周及對照組比較尿MCP-1水平顯著增高,差異有顯著性(P0.05),且顯著高于SSNS組治療后8周(P0.05),與SRNS組治療后8周比較無顯著差異(P0.05)。 3. SSNS組治療前、治療后8周尿IL-18水平均高于正常對照組,差異有顯著性(P0.05)；治療16周后顯著低于治療前、治療后8周(P0.05)。SRNS組治療前顯著高于SSNS組治療前與對照組(P0.05),但與治療后8周比較無顯著差異(P0.05),當聯(lián)合免疫抑制劑環(huán)磷酰胺治療16周后則顯著低于治療前、治療后8周(P0.05)。分別對三個時間點SRNS組和SSNS組患兒尿IL-18的水平進行比較,SRNS均顯著高于SSNS組(P0.05)。 4. FRNS組患兒治療前、治療后8周尿IL-18水平顯著高于正常對照組(P0.05),與SSNS組比較無顯著差異(P0.05)；但顯著低于SRNS組(P0.05)。當病情反復時,與治療前、治療后8周及對照組比較尿IL-18水平顯著增高(P均0.05),且顯著高于SSNS組治療8后周(P0.05),與SRNS組治療后8周比較無顯著差異(P0.05)。 5.尿MCP-1及IL-18與血尿素氮、肌酐之間無相關(guān)性,與24小時尿蛋白定量呈顯著正相關(guān)。另外尿MCP-1水平與尿IL-18水平有相關(guān)性。 結(jié)論： 1.PNS患兒尿MCP-1及IL-18水平均升高,尤其在SRNS組顯著高于SSNS組,提示在糖皮質(zhì)激素治療初期檢測尿MCP-1及IL-18有助于早期預測患兒對糖皮質(zhì)激素的敏感性,從而為臨床醫(yī)師制定合理治療方案提供實驗室依據(jù)。 2.MCP-1及IL-18在尿液中的水平升高可以判斷PNS疾病活動性,為臨床醫(yī)師提早啟動更為合理的治療方案提供理論依據(jù)。 3.尿MCP-1及IL-18水平增高,結(jié)合PNS患兒的臨床癥狀及蛋白尿等指標可作為監(jiān)測腎病反復的無創(chuàng)的重要指標。
[Abstract]:Purpose :

The levels of monocyte chemoattractant protein - 1 ( MCP - 1 ) and interleukin - 18 ( IL - 18 ) in urine of children with primary nephrotic syndrome ( PNS ) were examined .

Method :

In this study , 65 PNS children hospitalized in our hospital were selected as the subjects . The results were divided into three groups : hormone - sensitive nephrotic syndrome ( SSNS ) , 35 cases of hormone - resistant nephrotic syndrome ( SRNS ) , 15 cases of recurrent nephrotic syndrome ( FRNS ) .
At the second point of time , a sufficient amount of GC was used for 8 weeks ;
The levels of MCP - 1 and IL - 18 in urine of children with PNS were measured by ELISA . The levels of MCP - 1 and IL - 18 in urine were measured by ELISA . Blood urea nitrogen , creatinine and 24 - hour urinary protein were measured at different time points in children with PNS .

Results :

1 . Before treatment , the level of MCP - 1 in urine was higher than that of control group before and after treatment ( P0.05 ) .
The levels of MCP - 1 in the SRNS group were significantly higher than those in the control group ( P0.05 ) before and 8 weeks after treatment ( P0.05 ) . The levels of urinary MCP - 1 were significantly lower in SRNS group than in SSNS group ( P < 0.05 ) .

2 . There was no significant difference between the levels of MCP - 1 and the SSNS group ( P0.05 ) before and after treatment in the FRNS group , but significantly lower than that in SRNS group ( P0.05 ) .

3 . Before treatment , the levels of urinary IL - 18 were higher in 8 weeks after treatment than those in the normal control group ( P0.05 ) .
The levels of urinary IL - 18 in SRNS group and SSNS group were significantly lower than those in control group before and 8 weeks after treatment ( P0.05 ) . The levels of urinary IL - 18 were significantly higher in SRNS group and SSNS group than in SSNS group ( P0.05 ) .

4 . The levels of urinary IL - 18 before and after treatment in FRNS group were significantly higher than those in the normal control group ( P0.05 ) , but there was no significant difference compared with the SSNS group ( P0.05 ) .
Compared with SRNS group ( P0.05 ) , the levels of urinary IL - 18 were significantly higher than that in SRNS group ( P < 0.05 ) , and significantly higher than that in SSNS group after 8 weeks ( P0.05 ) . There was no significant difference between the 8 weeks after treatment with SRNS group ( P0.05 ) .

5 . There was no correlation between urinary MCP - 1 and IL - 18 and blood urea nitrogen and creatinine .

Conclusion :

1 . The levels of urinary MCP - 1 and IL - 18 in children with PNS increased , especially in SRNS group than in SSNS group , suggesting that MCP - 1 and IL - 18 could be used to predict the sensitivity of children to glucocorticoid in the early stage of glucocorticoid therapy , thus providing laboratory basis for clinicians to develop rational treatment plan .

2 . The level of MCP - 1 and IL - 18 in urine can judge the activity of PNS and provide theoretical basis for the clinician to start a more reasonable treatment plan early .

3 . The levels of urinary MCP - 1 and IL - 18 were increased , and the clinical symptoms and proteinuria indexes of the children with PNS could be used as an important index for the monitoring of recurrent renal disease .
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R726.9

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