【摘要】 目的:探讨血、尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平与IgA肾病(IgAN)患者临床与病理表现的关系。方法:选择初次诊治经肾活检病理检查确诊为IgAN且未经激素或免疫抑制剂治疗的患者40例,同时选择10例健康体检者作为对照。收集临床和病理资料,应用酶联免疫吸附法(ELISA)检测血、尿NGAL水平,并分别用IgAN牛津分型和Katafuchi半定量标准对病理进行评分。分析血、尿NGAL与IgAN患者临床及病理指标的相关性。结果:血、尿NGAL反映IgAN肾功能情况较血肌酐(Scr)、血尿素氮(BUN)更敏感,与高血压、Scr、BUN、牛津分型的系膜增殖积分(M)、间质纤维化或小管萎缩(T)以及Katafuchi分型的系膜增殖、局灶节段病变、球性硬化、炎细胞浸润、间质纤维化、肾小管萎缩、血管壁增厚、小动脉玻变等多个指标相关性分析差异均有统计学意义(P<0.05,部分P<0.01),尤其与肾小管间质损伤各项指标(炎细胞浸润、间质纤维化、肾小管萎缩)显著相关(r均>0.6,P<0.01)。ROC曲线表明血、尿NGAL在IgAN中反映小管间质病变程度方面明显优于Scr和肾小球滤过率(eGFR),血NGAL在反映小管间质病变程度方面比尿NGAL敏感度和特异度更高。结论:血、尿NGAL水平与IgA肾病临床及病理多个指标相关,更能反映肾小管间质损伤程度,可以作为评估IgA肾病小管间质病变的早期无创性指标。更多还原

【Abstract】 Objective: To investigate the relationship between serum and urine neutrophil gelatinase - associated lipocalin ( sNGAL and uNGAL) level and clinical and pathological features of IgA nephropathy( IgAN) . Methods: 40 cases of biopsy proven IgAN patients at first onset without glucocorticoids and/or immunosuppresants therapy were enrolled in the study. 10 healthy persons matched in age and sex were selected as a control. The clinical and pathological data were collected. The sNGAL and uNGAL were measured by enzyme linked immunosorbent assay. The kidney pathological score were evaluated with IgAN Oxford classification crite- ria and Katafuchi semi - quantitation criteria. The relationship between sNGAL and uNGAL and clinical and pathological features of IgAN were analysed. Results: sNGAL and uNGAL were more sensitive on reflecting renal function than serum creatinine( Scr) and blood urea nitrogen( BUN) in IgAN patients. The correlation analysis in clinical and pathological index such as hypertension,Scr, BUN,mesangial proliferation( M) ,interstitial fibrosis,renal tubule atrophy( T) on Oxford criteria and mesangial proliferation,focal segmental lesion,global sclerosis,inflammatory cell infiltration,interstitial fibrosis,tubule atrophy on Katafuchi semi - quantitation criteria had significant differences statistically ( P < 0. 05,partly P < 0. 01) ,especially in renal tubule and interstitial lesion including inflammatory cell infiltration,interstitial fibrosis and tubule atrophy( correlation coefficient > 0. 6,P < 0. 01) . Receiver operating characteristic( ROC) indicated that sNGAL and uNGAL were more sensitive than Scr and eGFR on reflecting the pathological damage in renal tubule and interstitium,while sNGAL was a more sensitive and specific than uNGAL. Conclusion: sNGAL and uNGAL were closely related with clinical and pathological features of IgA nephropathy. sNGAL and uNGAL were more sensitive and specific on re- flecting the clinical and pathological lesions in IgAN ,especially in renal tubule and interstitium. sNGAL and uNGAL could be sensi- tive markers to evaluate renal damage in IgA nephropathy.更多还原