本文關(guān)鍵詞： 腎病綜合征 漿膜腔積液 低蛋白血癥 糖類抗原 125糖類抗原 199糖類抗原153　出處：《昆明醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過回顧性研究原發(fā)性腎病綜合征患者在不同血漿白蛋白水平、腎功能水平以及伴漿膜腔積液等情況下,血清中糖類抗原(Cancer Associated Antigen125),CA125.(Cancer Associated Antigen199),CA199.(Cancer Associated Antigen153),CA153的濃度變化,并對(duì)影響以上3種糖類抗原可能的影響因素進(jìn)行了統(tǒng)計(jì)學(xué)分析,為臨床診斷糖類抗原升高的腎病綜合征患者,提供診斷及治療的科學(xué)依據(jù)。 方法回顧性研究：收集既往2012年1月至2013年10月在昆明醫(yī)科大學(xué)第一附屬醫(yī)院腎內(nèi)科住院,出院時(shí)確診為原發(fā)性腎臟病、各種臨床檢驗(yàn)資料完整、排外既往腫瘤病史、心血管疾病、內(nèi)分泌疾病、全身免疫性疾病及病毒性肝炎、肺結(jié)核的患者150名,平均年齡(41.03±18.34)歲,其中男性患者74名,女性76名。對(duì)照組隨機(jī)選取來(lái)我院體檢的健康人群127名,平均年齡(42.46±15.69)歲,其中男性64名,女性63名。所有入選人員行腫瘤標(biāo)志物全套、血生化檢查。將患者組與正常對(duì)照組的3項(xiàng)腫瘤標(biāo)志物CA125、 CA199、CA153水平進(jìn)行比較,并根據(jù)有無(wú)漿膜腔積液、有無(wú)低蛋白血癥、有無(wú)腎功能不全、有無(wú)絕經(jīng)將NS患者組間3項(xiàng)腫瘤標(biāo)志物水平及常規(guī)腎臟功能生化指標(biāo)進(jìn)行兩兩比較,并對(duì)NS組中可能影響腫瘤標(biāo)志物水平因素進(jìn)行相關(guān)性及危險(xiǎn)因素分析。統(tǒng)計(jì)學(xué)方法采用SPSS17.0. 結(jié)果腎病綜合征患者糖類抗原CA125、CA199、CA153陽(yáng)性率及濃度水平均較正常對(duì)照組升高(P0.05)；腎病綜合征組中生化指標(biāo)白蛋白、尿素氮、血清肌酐、尿酸、血清肌酐清除率均較正常對(duì)照組有變化(P0.05)。在有無(wú)漿膜腔積液兩組比較中,糖類抗原CA125差異具有統(tǒng)計(jì)學(xué)差異(P0.05),CA199、CA153差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)：而該組生化指標(biāo)比較中白蛋白、血清肌酐、尿素氮間差異具有統(tǒng)計(jì)學(xué)意義(P0.05),尿酸、肌酐清除率在兩組中差異無(wú)統(tǒng)計(jì)學(xué)意義。在腎病綜合征組有無(wú)低蛋白血癥兩組比較中,低蛋白血癥組糖類抗原CA125、CA153水平高于非低蛋白血癥組,兩者差異具有統(tǒng)計(jì)學(xué)意義(P0.05),CA199間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；兩組生化指標(biāo)比較,尿素氮、肌酐、尿酸、肌酐清除率間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。在腎病綜合征組中不同性別患者中CA125、CA199、CA153間差異均無(wú)統(tǒng)計(jì)學(xué)意義；在腎病綜合征組的女性患者中,有、無(wú)絕經(jīng)組患者糖類抗原CA125、CA199、CA153間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。分別對(duì)3種糖類抗原的相關(guān)性及危險(xiǎn)因素分析結(jié)果示：白蛋白、血清肌酐與CA125間存在統(tǒng)計(jì)相關(guān)(P0.05),CA125與血清肌酐呈正相關(guān),與白蛋白呈負(fù)相關(guān)；對(duì)其危險(xiǎn)因素分析示,白蛋白、血清肌酐、肌酐清除.率、有無(wú)漿膜腔積液是腎病綜合癥患者CA125升高的影響因素(P0.05),其中肌酐清除率是保護(hù)性因素(OR1),其余為危險(xiǎn)因素(OR1)；CA199與白蛋白、血肌酐、尿素氮、尿酸、肌酐清除率間無(wú)相關(guān)性(P0.05),對(duì)升高危險(xiǎn)因素分析,以上研究因素亦不是糖類抗原CA199發(fā)病的危險(xiǎn)因素(OR1)；CA153與血漿白蛋白呈負(fù)相關(guān)(P0.005),危險(xiǎn)因素分析則提示血清肌酐水平是其發(fā)病危險(xiǎn)因素(OR1)。 結(jié)論腎病綜合征時(shí)患者血清糖類抗原CA125、CA199、CA153濃度可有不同程度升高,其中糖類抗原CA125與血清肌酐呈正相關(guān),與白蛋白呈負(fù)相關(guān)；血漿白蛋白、血清肌酐、有漿膜腔積液是CA125升高的危險(xiǎn)因素,肌酐清除率正常則是其保護(hù)性因素。糖類抗原CA199與本研究中可能影響因素間不存在相關(guān)性,本研究中可能因素亦不是其升高的危險(xiǎn)因素。對(duì)糖類抗原CA153研究則發(fā)現(xiàn),血漿白蛋白與其呈負(fù)相關(guān),而血清肌酐水平則是其發(fā)病危險(xiǎn)因素。
[Abstract]:Objective To retrospectively study the patients with primary nephrotic syndrome in different levels of plasma albumin, renal function and the level of patients with serous cavity effusion under conditions of serum carbohydrate antigen (Cancer Associated Antigen125), CA125. (Cancer Associated Antigen199), CA199. (Cancer Associated Antigen153), the change of CA153 concentration, and the influence of the above factors effect of 3 kinds of carbohydrate antigens analyzed for clinical diagnosis, increased carbohydrate antigen in patients with nephrotic syndrome, provide scientific basis for diagnosis and treatment.
Methods: from January 2012 to October 2013 had been collected from Department of nephrology in First Affiliated Hospital of Kunming Medical University, was diagnosed as primary renal disease, the clinical testing data integrity, exclusion of known history of cancer, cardiovascular diseases, endocrine diseases, systemic autoimmune diseases and viral hepatitis, pulmonary tuberculosis in 150 patients, average age (41.03 + 18.34) years old, of which 74 were male, 76 were female. The control group were randomly selected from healthy people in our hospital for 127 persons, the average age (42.46 + 15.69) years, 64 males and 63 females. All the selected staff for tumor marker set, blood biochemical examination. 3 tumor patients group and normal control group markers CA125, CA199, CA153 levels were compared, and according to the presence or absence of serous effusion, there is no hypoproteinemia, without renal dysfunction, there is no NS between the two groups of patients postmenopausal 3 The level of tumor markers and routine renal function and biochemical indexes were compared by 22. The correlation and risk factors of tumor markers in group NS were analyzed. The statistical method was SPSS17.0..
Results the patients with nephrotic syndrome antigen CA125, CA199, CA153 positive rate and the concentration levels were increased compared to normal control group (P0.05); nephrotic syndrome syndrome group and biochemical indexes of albumin, urea nitrogen, serum creatinine, uric acid, serum creatinine clearance rate were higher than the normal control group (P0.05). The change in no serosa the comparison between the two groups in the effusion, carbohydrate antigen CA125 had a significant difference (P0.05, CA199), there was no significant difference of CA153 (P0.05), albumin, and the set of biochemical indicators in serum creatinine, urea nitrogen difference have statistical significance (P0.05), uric acid, creatinine clearance rate in the two groups had no difference statistical significance. In nephrotic syndrome group without hypoproteinemia in two groups, hypoproteinemia group carbohydrate antigen CA125, CA153 levels higher than the non hypoproteinemia group, the difference has statistical significance (P0.05), CA199 was no difference. Yi (P0.05); compared two groups of blood urea nitrogen, creatinine, uric acid, creatinine clearance rate and there were no significant difference (P0.05). CA199 in nephrotic syndrome group in different gender patients in CA125, CA153, and there were no significant difference in female patients with nephrotic syndrome; syndrome group, have no, menopause group patients with carbohydrate antigen CA125, CA199, CA153 and there were no significant difference (P0.05). The correlation and risk of the 3 kinds of carbohydrate antigen factor analysis showed that albumin, serum creatinine has statistical correlation between CA125 and CA125 (P0.05), and serum creatinine were positively correlated, negatively correlated with albumin; the risk factor analysis, albumin, serum creatinine, creatinine clearance rate. There is no effusion, influencing factors of patients with nephrotic syndrome CA125 (P0.05), which elevated creatinine clearance is a protective factor (OR1) and other risk factors (OR1); CA199 and albumin, serum creatinine, urea nitrogen, uric acid, creatinine clearance rate (P0.05), no correlation between the increase of analysis of risk factors, risk factors of above factors are also not carbohydrate antigen CA199 (OR1); the incidence of CA153 was negatively correlated with serum albumin (P0.005), risk factors analysis suggested that serum creatinine level is the risk factors (OR1).
Conclusion nephrotic syndrome patients serum carbohydrate antigen CA125, CA199, CA153 concentration can be increased to different extent, the carbohydrate antigen CA125 and serum creatinine were positively correlated negatively correlated with albumin; plasma albumin, serum creatinine, with serous effusion are the risk factors of elevated CA125, normal creatinine clearance is the protective possible factors. There is no correlation between influence factors and carbohydrate antigen CA199 in this study, possible factors in this research is not the elevated risk factors. The study of CA153 carbohydrate antigens that are negatively correlated with plasma albumin, and serum creatinine levels are risk factors.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692

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