本文關(guān)鍵詞： 抗中性粒細(xì)胞胞漿抗體相關(guān)性腎炎 尿中性粒細(xì)胞明膠酶相關(guān)脂質(zhì)運載蛋白 腎臟損傷分子-　出處：《中國實用內(nèi)科雜志》2017年04期 　論文類型：期刊論文

【摘要】：目的分析尿中性粒細(xì)胞明膠酶相關(guān)脂質(zhì)運載蛋白(neutrophil gelatinase-associated lipocalin,NGAL)及腎臟損傷分子-1(kidney injury molecule-1,KIM-1)與抗中性粒細(xì)胞胞漿抗體(anti-neutrophil cytoplasmic antibody,ANCA)相關(guān)性腎炎(ANCA associated glomerulonephritis,AAGN)嚴(yán)重程度及預(yù)后的關(guān)系。方法回顧2009年4月至2013年11月間南京軍區(qū)南京總醫(yī)院腎臟科住院的69例AAGN患者,其中抗過氧化物酶抗體陽性61例,抗蛋白酶3抗體陽性8例,腎活檢進(jìn)行病理分型及腎小管間質(zhì)炎癥細(xì)胞浸潤和腎間質(zhì)纖維化及腎小管萎縮半定量積分。尿NGAL及KIM-1采用ELISA方法檢測,Spearman檢驗分析尿NGAL及KIM-1與腎臟損害指標(biāo)(血肌酐、尿蛋白及血白蛋白)的關(guān)系,采用Mann-Whitney檢驗比較組間差異,分析尿NGAL及KIM-1與腎小管病變評分及腎臟預(yù)后的關(guān)系。結(jié)果69例AAV腎臟病理類型:局灶型14例,新月體型26例,混合型29例。基線肌酐:276.69(47.74~1193.40)μmol/L,24 h尿蛋白定量1.61(0.11~9.78)g。3種病理類型之間尿NGAL及KIM-1差異無統(tǒng)計學(xué)意義。尿NGAL與尿蛋白及Scr呈正相關(guān)(r值分別為0.3242、0.3257,P分別為0.0095、0.0081),與血清白蛋白呈負(fù)相關(guān)(r=-0.3964,P=0.0009)。尿KIM-1與血清白蛋白呈負(fù)相關(guān)(r=-0.2539,P=0.0413),但與血肌酐及尿蛋白無相關(guān)性。尿KIM-1與腎間質(zhì)浸潤細(xì)胞程度相關(guān),差異有統(tǒng)計學(xué)意義(P=0.0413)。尿NGAL與腎間質(zhì)浸潤細(xì)胞程度無相關(guān)性。45例隨訪24(14~58)個月,13例進(jìn)入終末期腎臟疾病者基線尿NGAL高于未進(jìn)入終末期腎臟疾病者[(117.6(3.06~518.4)μg/L對28.86(2.17~461.5)μg/L,P=0.0372)],多因素COX回歸分析示尿NGAL為不良腎臟預(yù)后的獨立危險因素(HR 1.012,95%CI 1.001~1.022,P=0.033)。結(jié)論尿NGAL水平反映AAGN的嚴(yán)重程度,為不良腎臟預(yù)后的獨立危險因素,而KIM-1與間質(zhì)浸潤細(xì)胞程度相關(guān)。
[Abstract]:Analysis of urinary neutrophil gelatinase associated lipocalin (neutrophil gelatinase-associated lipocalin, to NGAL) and -1 (kidney injury kidney injury molecule molecule-1, KIM-1) and anti neutrophil cytoplasmic antibody (anti-neutrophil cytoplasmic antibody ANCA (ANCA associated glomerulonephritis) gn, AAGN) the relationship between the severity and prognosis. Methods: April 2009 to November 2013, Nanjing general Hospital of Nanjing military hospital kidney in 69 AAGN patients, including anti peroxidase antibody positive in 61 cases, 3 anti protease antibody positive in 8 cases, renal biopsy pathology and renal tubular interstitial inflammatory cell infiltration and renal interstitial fibrosis and tubular atrophy. Semi quantitative urine NGAL and KIM-1 detected by ELISA, NGAL and KIM-1 Spearman analysis of urine and kidney damage indexes (serum creatinine, urine protein and blood white eggs White) relationship, were analyzed by Mann-Whitney test, analysis of the relationship between urinary NGAL and KIM-1 with renal tubular lesion score and renal prognosis. Results 69 cases of AAV type of renal pathology in focal crescentic type in 14 cases, 26 cases, 29 cases of mixed type. Baseline creatinine: 276.69 (47.74~ 1193.40) mol/L. 24 h urinary protein 1.61 (0.11~9.78) there was no significant difference between G.3 KIM-1 and urinary NGAL pathological types. The urinary NGAL was positively correlated with urinary protein and Scr (r = 0.3242,0.3257, P = 0.0095,0.0081), and negatively correlated with serum albumin (r=, -0.3964, P=0.0009). The urinary KIM-1 was negatively correlated with serum albumin (r=-0.2539, P=0.0413), but no correlation with serum creatinine and urine protein. KIM-1 in urine and renal interstitial cell infiltration degree, the difference was statistically significant (P=0.0413). The NGAL in urine and renal interstitial cell infiltration degree had no correlation between.45 cases were followed up for 24 months, 13 (14~58) Cases of end-stage renal disease at baseline urinary NGAL was higher than that of end-stage renal disease ([117.6 (3.06~518.4) g/L 28.86 (2.17~461.5) g/L, P=0.0372), COX regression analysis showed the independent risk factors for poor prognosis of kidney and urinary NGAL (HR 1.012,95%CI 1.001~1.022, P=0.033). Conclusion urine NGAL level can reflect the severity of AAGN, independent risk factors and adverse renal outcome, KIM-1 and interstitial infiltrating cells is related to the degree.

【作者單位】： 南京軍區(qū)南京總醫(yī)院國家腎臟疾病臨床醫(yī)學(xué)研究中心;
【基金】：國家科技支撐課題(2013BAI09B04,2015BAI12B05)
【分類號】：R692.3

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