【摘要】：目的本研究應用聲觸診組織定量分析(VTQ)技術(shù)檢測原發(fā)性腎病綜合征(PNS)患兒及健康兒童腎實質(zhì)的剪切波速(SWV),同時測定所有患兒血清骨形態(tài)發(fā)生蛋白-7(BMP-7)及結(jié)締組織生長因子(CTGF)水平,比較各組間的血清BMP-7、CTGF水平及腎實質(zhì)SWV,并將腎實質(zhì)SWV與血清BMP-7、CTGF水平進行相關性分析,探討血清BMP-7、CTGF與腎實質(zhì)SWV在小兒PNS腎間質(zhì)纖維化診治中的應用價值。方法將150例PNS患兒根據(jù)腎穿刺病理結(jié)果,按照腎間質(zhì)損害程度分為輕、中、重度間質(zhì)纖維化三組,另選擇50例健康兒童作為對照組,用酶聯(lián)免疫吸附實驗(ELISA)方法檢測各組血清BMP-7、CTGF水平,并利用VTQ技術(shù)檢測各組腎實質(zhì)SWV,比較各組間的血清BMP-7、CTGF水平及腎實質(zhì)SWV,然后將PNS組的血清BMP-7、CTGF水平與SWV進行相關性分析。結(jié)果對照組、小兒PNS組在年齡、性別、體質(zhì)量指數(shù)方面差異均無統(tǒng)計學意義(P0.05);對照組與小兒PNS組BUN、CRE無統(tǒng)計學差異,24h Ualb、血漿總蛋白、血漿膽固醇差異顯著(P0.05);血清BMP-7水平:輕度組中度組重度組,血清CTGF水平:輕度組中度組重度組,腎實質(zhì)SWV測值:輕度組中度組重度組;輕度腎間質(zhì)纖維化組與對照組比較血清BMP-7、CTGF水平及腎實質(zhì)SWV差異均無統(tǒng)計學意義,中、重度間質(zhì)纖維化組與對照組比較差異均有統(tǒng)計學意義(P0.05);小兒PNS不同腎間質(zhì)纖維化分期組間兩兩比較,血清BMP-7、CTGF水平及腎實質(zhì)SWV差異也均有統(tǒng)計學意義(P0.05);血清BMP-7水平與CTGF水平呈顯著負相關(r=-0.798、-0.672,P0.05),血清BMP-7水平與腎實質(zhì)SWV呈顯著負相關(r=-0.672,P0.05),血清CTGF水平與腎實質(zhì)SWV呈顯著正相關(r=0.702,P0.05)。結(jié)論PNS患兒腎實質(zhì)SWV隨腎間質(zhì)纖維化程度的增加而升高,證實剪切波彈性成像技術(shù)可反映小兒腎病綜合征腎間質(zhì)損害的程度。血清BMP-7水平隨PNS患兒腎間質(zhì)纖維化程度的增加而減低,而CTGF水平、腎實質(zhì)SWV則隨腎間質(zhì)纖維化程度的增加而升高,并可間接反映血清BMP-7水平,三者在PNS腎間質(zhì)纖維化診治中的有重要的應用價值。
[Abstract]:Objective to detect shear wave velocity (SWV),) of renal parenchyma in children with primary nephrotic syndrome (PNS) and healthy children by quantitative analysis of tissue with acoustic palpation (VTQ). Serum levels of bone morphogenetic protein-7 (BMP-7) and connective tissue growth factor (CTGF) were measured in all children at the same time. The levels of serum BMP-7,CTGF and renal parenchymal SWV, were compared among the groups. The renal parenchymal SWV was compared with the serum BMP-7,. To investigate the value of serum BMP-7,CTGF and renal parenchymal SWV in the diagnosis and treatment of renal interstitial fibrosis in children with PNS. Methods according to the pathological results of renal puncture, 150 cases of PNS were divided into three groups: mild, moderate and severe interstitial fibrosis according to the degree of renal interstitial damage, and 50 healthy children were selected as control group. The level of serum BMP-7,CTGF was detected by enzyme linked immunosorbent assay (ELISA), and the serum BMP-7,CTGF level of renal parenchyma and renal parenchymal SWV, were compared by VTQ technique. Then the serum BMP-7, of PNS group was measured. The correlation between CTGF level and SWV was analyzed. Results there was no significant difference in age, sex and body mass index between PNS group and control group (P0.05). There was no significant difference in BUN,CRE between control group and pediatric PNS group, but there was significant difference in plasma total protein and cholesterol in 24 h Ualb, (P0.05). Serum BMP-7 level: mild moderate group severe group, serum CTGF level: mild moderate group severe group, renal parenchyma SWV value: mild moderate group severe group; There was no significant difference in serum BMP-7,CTGF level and renal parenchymal SWV between mild renal interstitial fibrosis group and control group, while there was significant difference between severe interstitial fibrosis group and control group (P0.05). There were significant differences in serum BMP-7,CTGF level and renal parenchymal SWV between different stages of renal interstitial fibrosis in children with PNS (P0.05). There was a significant negative correlation between serum BMP-7 level and CTGF level (P 0.05), and a significant negative correlation between serum BMP-7 level and renal parenchymal SWV (P 0.05). Serum CTGF level was positively correlated with renal parenchymal SWV (r = 0.702 P 0.05). Conclusion SWV of renal parenchyma in children with PNS increases with the increase of renal interstitial fibrosis. It is confirmed that shear wave elastography can reflect the extent of renal interstitial damage in children with nephrotic syndrome. The serum BMP-7 level decreased with the increase of renal interstitial fibrosis, while the level of CTGF and renal parenchymal SWV increased with the increase of renal interstitial fibrosis, which could indirectly reflect the level of serum BMP-7. They have important application value in the diagnosis and treatment of PNS renal interstitial fibrosis.
【學位授予單位】：青島大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R726.9;R445.1

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