摘要
目的探讨血半胱氨酸蛋白酶抑制剂C（血Cys—C）、尿半胱氨酸蛋白酶抑制剂C（尿Cys-C）、尿视黄醇结合蛋白（RBP）、尿中性粒细胞明胶酶相关载脂蛋白（NGAL）在早期评估多发性骨髓瘤（MM）肾损害中的作用及在MM不同病理类型肾损害中的变化特点。方法根据肾少球滤过率估计值将MM患者分成两组，A组为肾功能正常组，B组为。肾功能损害组。以同期性别和年龄相匹配的健康志愿者为对照。检测患者血Cys-C、尿Cys-C、尿RBP、尿NGAL及血清肌酐（Scr）、尿微量蛋白（MAU）、尿d1一微球蛋白（α1—MG），同时对血Cys-C、尿Cys-C、尿RBP、尿NGAL异常且有意愿的患者行肾穿刺活检。结果①A组MM患者与健康对照组相比，血Cys—C、尿RBP、尿Cys—C、尿NGAL均高于健康对照组（P值均〈0．05）。6例实验指标异常的A组患者行。肾穿刺活检术，活检结果提示均有不同程度的肾损害，且血Cys—C、尿Cys—C、尿RBP、尿NGAL异常率分别为66．7％、66．7％、66．7％、83．3％。@24例实验指标异常的MM患者行肾穿刺活检术，其中淀粉样变性组6例，管型肾病（CN）组12例，免疫球蛋白沉积病（MIDD）组6例。CN组与MIDD组、淀粉样变性组相比，尿Cys—C、尿NGAL明显升高（P〈0．05）。MIDD组与CN组、淀粉样变性组相比，尿RBP明显升高（P=0．043）。淀粉样变性组与CN组、MIDD组相比，MAU明显升高（P=0．006）。结论与传统指标相比，血Cys—C、尿Cys．C、尿RBP、尿NGAL能更有效地早期评估MM患者肾损害。淀粉样变性组患者MAU明显升高，CN组患者尿Cys—C、尿NGAL明显升高，MIDD组患者尿RBP明显升高。
Objective To investigate the value of serum cystatin C （Cys-C）, urinary Cys-C, urinary retinol binding protein （RBP） and urinary neutrophil gelatinase-associated lipocalin （NGAL） in the early assessment of multiple myeloma （ MM ） and their characteristic changes in different pathological types of renal impaitment. Methods According to glomerular filtration rate （ eGFR）, the patients were divided into two groups, of which marked group A with normal renal function, the other marked group B with abnormal renal function. Sixty healthy subjects were chosen as control. Detection of the serum Cys-C, urinary RBP, urinary Cys-C, urinary NGAL, serum creatinine （Scr） , urinary microalbumin （MAU） and urinary ctl-microglobulin （or1-MG） were performed. Renal biopsy was carried out for patients who had abnormal serum Cys-C, urinary Cys-C, urinary RBP, urinary NGAL and were willing to accept further test. Results Compared with healthy controls, the serum Cys-C, urinary RBP, urinary Cys-C, urinary NGAL of group A were significantly higher than that of healthy controls. Six group A patients received renal biopsy, and varying degrees of renal damage were discovered. The serum Cys-C, urinary RBP, urinary Cys-C and urinary NGAL positive rate were 66.7% , 66.7% , 66.7% and 83.3%, respectively. Of twenty-four cases received biopsy after abnormal examination results were shown, six turned out to be amyloidosis, twelve cast nephropathy （CN） and 6 monoclonal immunoglobulin deposition disease （MIDD）. Compared with MIDD and amyloidosis, the urinary Cys-C and NGAL of the CN group are significantly higher （P 〈 0.05 ）. Compared with CN and amyloidosis, urinary RBP of MIDD is significantly higher （P = 0.043）. Compared with MIDD and CN, the MAU of amyloidosis is significantly higher （P = O. 006）. Conclusion Compared with the conventional indicators, serum Cys-C, urinary Cys-C, RBP and NGAL are more sensitive in early assessment of MM patients with renal damage. The MAU is higher in amyloid, the urinary Cys-C and urinary NGAL are significantly elevated in CN, the urinary RBP is significantly elevated in MIDD.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2012年第10期819-822,共4页
Chinese Journal of Hematology
关键词
多发性骨髓瘤
肾损害
病理学
临床
Multiple myeloma
Renal impairment
Pathology, clinical
