目的 探讨胱抑素C(CysC)、纤维蛋白原(Fbg)浓度和24 h 尿蛋白定量与紫癜性肾炎(HSPN)患儿肾脏病理分级的相关性和应用价值。方法 收集2011 年1 月至2015 年1 月48 例经肾活检明确诊断为HSPN 患儿的病历资料,根据肾脏病理结果分为Ⅱ a 级及Ⅱ a 级以下12 例、Ⅱ b 级12 例、Ⅲ a 级17 例及Ⅲ b 级及Ⅲ b 级以上7 例。乳胶增强散射免疫比浊法检测所有患儿血清CysC,浊度法检测Fbg 浓度,终点法检测24 h 尿蛋白定量水平;采用Pearson 和Spearman 相关分析对各检测指标之间及各指标与肾脏病理分级之间进行相关分析。结果 血清CysC、Fbg 浓度和24 h 尿蛋白定量在各肾脏病理分级患儿中比较差异均有统计学意义(P<0.05),且各指标水平均随病理分级严重程度增高而上升(P<0.05)。48 例HSPN 患儿血清CysC 和Fbg与24 h 尿蛋白定量之间均呈正相关(分别r=0.51、0.63,P<0.05);Fbg 与血清CysC 之间呈正相关(r=0.55,P<0.05);CysC、Fbg 及24 h 尿蛋白定量与肾脏病理分级之间均呈正相关(分别r=0.66、0.64、0.68, 均P<0.05)。结论 CysC、Fbg 和24 h 尿蛋白定量均能反映肾脏损伤严重程度,对于HSPN 患儿肾脏损伤的严重程度具有较好的判断作用。
Abstract
Objective To study the relationship of cystatin C (CysC), fibrinogen (Fbg), and 24-hour urinary protein with renal pathological grade in children with Henoch-Schönlein purpura nephritis (HSPN), and to explore their values. Methods The clinical data of 48 children diagnosed with HSPN by renal biopsy from January 2011 to January 2015 were reviewed. According to renal pathological grading, in the 48 children with HSPN, 12 had stage IIa or lower, 12 stage IIb, 17 stage IIIa, and 7 stage IIIb or higher. The latex-enhanced immunoturbidimetric assay, turbidimetric measurement, and end-point method were used to determine the levels of serum CysC, Fbg, and 24-hour urinary protein, respectively. Pearson and Spearman correlation analyses were used to test the correlations between the indices and between the indices and renal pathological grade. Results There were significant differences in the levels of serum CysC, Fbg, and 24-hour urinary protein between patients with different pathological grades (P<0.05). The level of each index increased with increasing pathological grade (P<0.05). In the 48 children with HSPN, the level of 24-hour urine protein was positively correlated with the levels of serum CysC (r=0.51, P<0.05) and Fbg (r=0.63, P<0.05). The level of Fbg was positively correlated with that of serum CysC (r=0.55, P<0.05). The levels of CysC, Fbg, and 24-hour urinary protein were all positively correlated with renal pathological grade (r=0.66, 0.64 and 0.68; respectively, P<0.05). Conclusions The levels of CysC, Fbg, and 24-hour urine protein can reflect the severity of renal injury, providing satisfactory prediction of the severity of renal injury in children with HSPN.
关键词
胱抑素C /
纤维蛋白原 /
尿蛋白定量 /
紫癜性肾炎 /
儿童
Key words
Cystatin C /
Fibrinogen /
24-Hour urinary protein /
Henoch-Schönlein purpura nephritis /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 李玉飞, 鹿玲. 过敏性紫癜患儿血浆髓过氧化物酶、丙二醛、超氧化物歧化酶及总抗氧化能力水平变化[J]. 临床儿科杂 志, 2015, 33(4): 357-360.
[2] 赵建辉, 何红权. 过敏性紫癜肾炎诊治进展[J]. 中国中西医 结合肾病杂志, 2013, 14(4): 363-365.
[3] 丁佳锋, 蒋莉. 过敏性紫癜肾炎患儿t-PA 和PAI-1 检测的 临床意义[J]. 中国医师杂志, 2013, 15(5): 653-655.
[4] 廖翠玲, 金红君. 胱抑素C 在过敏性紫癜早期肾损伤中应用 价值探讨[J]. 重庆医学, 2014, 43(17): 2211-2213.
[5] 雷晓燕, 张宏, 赛依帕, 等. 实验室系列检查指标在早期诊 断过敏性紫癜肾损害的敏感度选择[J]. 实用儿科临床杂志, 2003, 18(1): 32-33.
[6] 段玉燕, 赵凯姝, 李青梅, 等. 儿童紫癜性肾炎尿蛋白定量 与肾脏病理相关性分析[J]. 中华临床医师杂志(电子版), 2014, 8(1): 91-95.
[7] Nickavar A, Mehrazma M, Lahouti A. Clinicopathologic correlations in Henoch-Schonlein nephritis[J]. Iran J Kidney Dis, 2012, 6(6): 437-440.
[8] 中华医学会儿科学分会免疫学组.《中华儿科杂志》编辑 委员会. 儿童过敏性紫癜循证诊治建议[J]. 中华儿科杂志, 2013, 51(7): 502-507.
[9] Ozden TA, Tekerek H, Baş F, et al. Effect of hypo-and euthyroid status on serum cystatin C levels[J]. J Clin Res Pediatr Endocrinol, 2010, 2(4): 155-158.
[10] 朱慧琪, 杜佳. 四种生化指标检测早期诊断糖尿病肾病的价 值[J]. 中国实用医刊, 2015, 42(8): 82-83.
[11] 刘华杰, 沈云琳, 孙蕾, 等. 补体应答基因-32 在儿童急性 肾损伤中的早期预测价值[J]. 中华儿科杂志, 2014, 52(7): 494-499.
[12] Vlaicu SI, Cudrici C, Ito T, et al. Role of response gene to complement 32 in diseases[J]. Arch Immunol Ther Exp (Warsz), 2008, 56(2): 115-122.
[13] Vlaicu SI, Tegla CA, Cudrici CD, et al. Epigenetic modifications induced by RGC-32 in colon cancer[J]. Exp Mol Pathol, 2010, 88(1): 67-76.
[14] Tegla CA, Cudrici CD, Azimzadeh P, et al. Dual role of Response gene to complement-32 in multiple sclerosis[J]. Exp Mol Pathol, 2013, 94(1): 17-28.
[15] 唐红梅, 姜振伟, 廖国林. 胱抑素C 的临床应用[J]. 国际检 验医学杂志, 2011, 32(2): 216-218.
[16] 李培敏. 血清胱抑素C 在肾脏疾病早期诊断的临床价值[J]. 国际检验医学杂志, 2009, 30(2): 157-158.
[17] 姚海林, 刘绍珍, 欧阳庆. 半胱氨酸蛋白酶抑制剂C(Cystatin C, Cys-C)测定在糖尿病肾功损伤中的应用[J]. 实验与检验 医学, 2010, 28(3): 308-309.
[18] 曹芳, 邓芳, 董扬, 等. 血清胱抑素C 水平在儿童过敏性紫 癜肾损害评价中的意义[J]. 安徽医科大学学报, 2014, 49(10): 1517-1520.
[19] 刘捷, 陈松盛, 陈银霞, 等. 紫癜性肾炎凝血筛选指标变化及 纤维蛋白原分子功能观察[J]. 临床血液学杂志, 2002, 15(3): 130.
[20] 周丽君, 卢国元. 血浆纤维蛋白原水平在肾小球疾病中的临 床意义[J]. 中国血液流变学杂志, 2013, 23(4): 640-642, 644.
[21] Garay RP, Hannaert P, Chiavaroli C. Calcium dobesilate in the treatment of diabetic retinopathy[J]. Treat Endocrinol, 2005, 4(4): 221-232.
[22] 俞蕾, 刘磊, 赵桂臣. 儿童紫癜性肾炎55 例临床与病理分析[J]. 临床儿科杂志, 2010, 28(7): 670-674.
[23] 刘冬妍, 文熠冰, 李航, 等. 蛋白尿在成人紫癜性肾炎中的 临床意义[J]. 中国医学科学院学报, 2005, 27(2): 237-240.
PDF(1359 KB)
