【摘要】 目的探讨慢性肾脏病(chronic kidney disease,CKD)患者血清人附睾分泌蛋白4(epididymis gene product 4,HE4)的变化以及和肾脏纤维化的关系。方法选取住院女性CKD患者190例,采用ELISA(双抗体夹心法)检测血清HEA,用MDRD公式计算肾小球滤过率。按照美国肾脏病基金会K/DOQI指南分期标准将上述患者分为5组,即CKD 1期组、CKD 2期组、CKD 3期组、CKD 4期组、CKD 5期组,检测并比较血清HEA的水平。选择其中89例住院接受肾穿刺活检的患者,包括CKD 1期组55例,CKD2期组15例,CKD3期组19例;并根据肾组织病理结果分为肾小球硬化组和无肾小球硬化组,分析肾小球硬化与血清HE4的关系。结果不同CKD分期组之间血清HE4水平差异有统计学意义(P<0.01)。肾功能不全患者(CKD 2~5期组)血清HEA水平高于肾功能正常患者(CKD 1期组)(P<0.05),其中CKD 2期组血清HEA水平高于CKD 1期组(P<0.01),CKD3期组血清HEA水平高于CKD2期组(P<0.01),CKD4期组血清HEA水平高于CKD3期组(P<0.01),CKD 5期组血清HE4水平高于CKD 4期组(P<0.01)。肾小球滤过率与血清HEA呈非线性负相关。在CKD 1~3期组中血清HE4的水平在肾小球硬化组与无肾小球硬化组之间无统计学差异(P>0.05)。结论在无妇科肿瘤的女性CKD患者中血清HEA会显著升高,并且HEA的血清水平会随着CKD临床分期的增加而逐渐增高。用HEA辅助诊断妇科肿瘤和评估肿瘤的复发及治疗效果时,应考虑CKD的影响。检测血清HEA水平是否能成为判断无妇科肿瘤的CKD患者肾脏纤维化发生的指标还有待临床研究。更多还原

【Abstract】 Objective To analyze the change of serum human epididymis protein 4 concentrations in chronic kidney disease and the relationship between serum HE4 and renal fibrosis.Methods In190 female patients at different stages of chronic kidney disease(CKD) with no ovarian and lung cancer,HE4 concentrations were analyzed by using Enzmy-linked immunosorbent assay(ELISA).Renal function was evaluated by measuring serum creatinine and urea concentrations.Estimated glomerular filtrationn rate(eGFR) was calculated by the MDRD formula,eighty-nine cases of CKD with stage 1 to 3 were divided into glomerulosclerosis group and no glomerulosclerosis group according to the renal pathological changes.Analyze the relationship between serum HE4 and renal fibrosis.Results The levels of serum HE4 in CKD group are differences(P<0.01).The levels of serum HE4 were significantly higher in the chronic renal insufficiency group(CKD2、CKD3、CKD4、CKD5groups) than those in normal renal function(P<0.05).The levels of serum HE4 were higher in CKD1 group than those in CKD2 group(P<0.05),The levels of serum HE4 were higher in CKD2 group than those in CKD3 group(P<0.001),The levels of serum HE4 were higher in CKD3 group than those in CKD4 group(P<0.001),The levels of serum HE4 were higher in CKD4 group than those in CKD5 group(P<0.001).The relationship between serum HE4 and GFR showed a negative nonlinear correlation.Results Serum HE4 concentrations showed no difference among glomerulosclerosis group and no glomerulosclerosis group(P>0.05).Conclusions HE4 concentrations may be elevated in CKD patients with no ovarian and lung cancer.Thus,HE4 results should be interpreted cautiously in women with renal disorders.Whether serum HE4 concentrations can become the indicator of renal fibrosis in patients with chronic kidney remains to be clinical research.更多还原