摘要
目的:探讨在不同类型肾脏病患者尿视黄醇结合蛋白(RBP)、尿N-乙酰-β-氨基葡萄糖苷酶(NAG酶)的变化特点及其与肾组织形态学改变的关系。方法:选择干燥综合征肾损害9例、慢性马兜铃酸肾病14例、IgA肾病169例、狼疮性肾炎83例,均行肾穿刺活检明确诊断,检测尿RBP、NAG酶、补体C3、α2巨球蛋白对肾小管间质的形态学改变进行半定量分级。分析上述四种肾脏病患者尿RBP、NAG酶的变化特点、与肾小管间质形态学改变之间的关系,及尿蛋白程度、蛋白尿选择性和肾功能对其的影响。结果:以肾小管间质损伤为主的干燥综合征肾损害及慢性马兜铃酸肾病,尿RBP、NAG酶与肾小管间质的形态学改变相关性良好,其水平高低直接反映肾小管间质的病变程度,受尿蛋白的质、量和肾功能的影响较小;在继发于IgA肾病、狼疮性肾炎肾小管间质损伤中,尿RBP、NAG酶的异常升高晚于肾小管间质的形态学改变而出现(IgA肾病尤为明显),且除肾小管间质病变外,其水平高低还明显受肾小球疾病本身的影响,大量蛋白尿、尿液中的大分子蛋白质、肾功能下降等均与尿RBP、NAG酶升高相关。结论:尿RBP、NAG酶是评价肾小管间质损伤的良好指标。尿RBP、NAG酶与肾小管间质的形态学改变之间存在一定联系。
Objective: Urinary N-acetyl-β-glucosaminidase(NAGase) and Retinal-binding protein(RBP) has been applied as sensitive clinical markers of acute tubulointerstial damage s. Further study is in need to evaluate their relevance with pathological change s and clinical functional changes in different entities of tubulointerstitial di sorders and glomerular diseases. In this study, we explored the relevance of the se markers with the tubulointerstitial lesion and glomerular function in classic al tubulointerstitial disorders as chronic aristolochic acid nephropathy (CAAN) and Sjogren syndrome related nephropathy (SSN), and in glomerulonephropathy as I gA nephropathy (IgAN) and lupus nephropathy (LN). Methodology:This study included 9 patients with SSN, 14 patients with CAAN, 169 patients wit h IgAN and 83 patients with type-Ⅳ or type-Ⅴ LN. All patients were hospitali zed for evaluation, and underwent a renal biopsy. Urinary RBP and NAGase were de termined with ELISA and colourimetric assay respectively. Other laboratory tests including urinary C3, urinary α 2M, 24 hour urinary protein excetion, and ser um creatinine (SCr) were studied. Histological changes of renal biopsy slides we re reviewed and graded semi-quantitatively according to the extent of tubulointe rstitial lesion. Changes of urinary RBP and NAG and their relationship with tubu lar interstitial damage were analyzed, with respect to the four different groups of patients. Influencing factors on urinary RBP and NAG were explored. Results:In patients with Sjogren's disease, CAAN, IgAN and LN, the percentages of patien ts with increased urine RBP and NAG were 100% and 88.89%、85.71% and 71.43 %、37.28% and 56.21%,69.88% and 97.59%, respectively. RBP and NAG excr etion increased while tubular-interstitial lesion deteriorate. In SSN and CAAN, The urinary excretion of RBP and NAG had no significant co-relationship with th at of urinary C3 and α 2M (P>0.05). There is no significant change of uri nary RBP and NAG when SCr increase (P>0.05). In IgAN, The excretion of RBP had significant co-relationship with that of urinary C3(P<0.01), the exc retion of NAG had significant co-relationship with that of urinary C3 and α 2 M(P<0.01). RBP and NAG excretion increased while 24h urine protein excret ion or SCr raised. In LN, The excretion of RBP and NAG had significant co-relat ionship with that of urinary C3 and α 2M respectively(P<0.01). The excr etion of NAG increased when 24h urine protein aggrandized(P<0.05)and that of RBP increased along with SCr. Conclusion:Examinations of urine RBP and NAG are effective methods for assessing renal tubu lar interstitial lesion. Urine RBP and NAG levels correlate with tubular interst itial historical change and show various characters in different nephropathies. In patients characterized by tubulointerstitial lesion, such as SSN and CAAN, ur inary RBP and urinary NAG correlated well with the extent of tubulointerstitial changes. In patients characterized by glomerular lesion and accompanied tubuloin terstitial changes, the extent of using RBP and urinary NAG are influenced by fa ctors including 24-hour urinary protein excretion, urinary protein selectivity, and serum levels of creatinine.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2005年第2期110-116,共7页
Chinese Journal of Nephrology,Dialysis & Transplantation
