山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (12): 74-79.doi: 10.6040/j.issn.1671-7554.0.2019.526
• • 上一篇
潘艳艳1,孙永超2,刘雪梅1,张洪霞1,周蔚然1,赵翠芬3
PAN Yanyan1, SUN Yongchao2, LIU Xuemei1, ZHANG Hongxia1, ZHOU Weiran1, ZHAO Cuifen3
摘要: 目的 探讨尿液α1-抗胰蛋白酶(AAT)、尿转铁蛋白(TRF)水平预测小儿原发性肾病综合征(PNS)激素治疗临床效果的价值。 方法 选取山东大学齐鲁儿童医院2016年5月至2017年6月PNS住院患儿90例,根据糖皮质激素治疗4周后的反应分为激素敏感组(n=60)和激素耐药组(n=30),选取同期30 例健康儿童为正常对照组,收集20 mL新鲜晨起尿,4 ℃离心,收集上清液。收集所有患儿基本资料以及激素治疗前后的血胆固醇、血肌酐、白蛋白、24 h尿蛋白定量等生化指标。采用酶联免疫吸附试验(ELISA)法检测尿液中AAT和TRF的浓度,并经尿肌酐(Cr)校正后分析其预测PNS患儿对激素治疗效果的反应。 结果 激素敏感组和激素耐药组的尿液AAT/Cr比值和TRF/Cr比值均高于正常对照组,差异具有统计学意义(P<0.05);激素敏感组和激素耐药组的尿液AAT/Cr比值和TRF/Cr比值差异有统计学意义(P<0.05);回归分析显示,尿液AAT/Cr比值和TRF/Cr比值是影响PNS激素治疗临床效果的危险因素(P<0.05)。 结论 激素耐药PNS患儿尿液中的AAT和TRF浓度均较激素敏感患儿升高;如果PNS患儿发病初期尿液中AAT和TRF浓度升高,提示可能为激素耐药。
中图分类号:
[1] 王丽君, 李建国. 儿童激素耐药型肾病综合征的分子遗传学机制研究进展[J]. 中国妇幼保健, 2018, 33(11): 2621-2625. WANG Lijun, LI Jianguo. Advances in molecular genetic mechanisms of steroid-resistant nephrotic syndrome in children[J]. China Maternal and Child Health Care, 2018, 33(11): 2621-2625. [2] 中华医学会儿科学分会肾脏病学组. 儿童常见肾脏疾病诊治循证指南(试行)(三):激素耐药型肾病综合征诊治指南[J].中华儿科杂志, 2010, 48(1): 72-75. The Subspecialty Group of Nephrology, Society of Pediatrics, Chinese Medical Association. Evidence-based guidelines on diagnosis and treatment of childhood common renal diseases(Ⅲ): guideline on diagnosis and treatment of steroid-resistant nephrotic syndrome[J].Chinese Journal of Pediatrics, 2010, 48(1): 72-75. [3] 黄付甲, 侯鸿雁. 小儿原发性肾病综合征患者血浆蛋白Z、凝血因子Ⅷ活性的检验分析[J]. 国际检验医学杂志, 2018, 39(7): 815-817. HUANG Fujia, HOU Hongyan. Pediatric primary nephrotic syndrome patients comprehensive detection of plasma protein Z and coagulation factor Ⅷ activity analysis[J]. International Journal of Laboratory Medicine, 2018, 39(7): 815-817. [4] 王荧荧. 预测儿童原发性肾病综合征激素疗效的尿液标志物研究[D]. 南京:南京医科大学, 2012. [5] 中华医学会儿科学分会肾脏病学组.儿童常见肾脏疾病诊治循证指南(一):激素敏感、复发/依赖肾病综合征诊治循证指南(试行)[J]. 中华儿科杂志, 2009, 47(3): 167-170. The Subspecialty Group of Nephrology, Society of Pediatrics, Chinese Medical Association. Evidence-based guidelines on diagnosis and treatment of childhood common renal diseases(Ⅰ)Evidence-bused guideline on diagnosis and treatment of steroid-sensitive, relapsing/steroid-dependent nephrotic syndrome(for trial implementation)[J].Chinese Journal of Pediatrics, 2009, 47(3): 167-170. [6] Zampini L, Padella L, Marchesiello RL, et al. Importance of the combined urinary procedure for the diagnosis of Mucopolysaccharidoses[J]. Clinica Chimica Acta, 2017, 464:165-169. doi: 10.1016/j.cca.2016.11.024. [7] Rachmiel M, Strauss P, Dror N, et al. Alpha-1 antitrypsin therapy is safe and well tolerated in children and adolescents with recent onset type 1 diabetes mellitus[J]. Pediatr Diabetes, 2016, 17(5): 351-359. [8] Behrman RE. Nelson textbook of pediatrics. 16th [M]. Phila-dephia: WB Sauders Company, 2000: 1500-1502. [9] Machado JR, Rocha LP, Neves PD, et al. An overview of molecular mechanism of nephrotic syndrome[J]. Int J Nephrol, 2012, 2012:937623. doi: 10.1155/2012/937623. [10] Kosuga M, Mashima R, Hirakiyama A, et al. Molecular diagnosis of 65 families with mucopolysaccharidosis type II(Hunter syndrome)characterized by 16 novel mutations in the IDS gene: genetic, pathological, and structural studies on iduronate-2-sulfatase [J]. Mol Genet Metab, 2016, 118(3): 190-197. [11] Subspecialty Group Of Nephrology, The Society Of Pediatrics Chinese Medical Association. [Multicenter study on present status of diagnosis and treatment of steroid-resistant nephrotic syndrome in children] [J]. Zhonghua Er Ke Za Zhi, 2014, 52(7): 483-487. [12] 王骞, 龚学忠. 急性肾损伤早期生物标志物研究及诊治进展[J]. 世界中西医结合杂志, 2014, 9(1): 105-108. [13] 聂静涛. 防己黄芪汤对原发性肾病综合征水肿期患者的疗效及对24 h尿蛋白、血清白蛋白、血脂的影响[J]. 实用临床医药杂志, 2017, 21(1): 48-51. NIE Jingtao. Effect of Fangji Huangqi decoction on edema of primary nephrotic syndrome and its effect on 24 h urinary protein, serum albumin and lipid [J]. Journal of Practical Clinical Medicine, 2017, 21(1): 48-51. [14] Franciosi AN, McCarthy C, McElvaney NG. The efficacy and safety of inhaled human α-1 antitrypsin in people with α-1 antitrypsin deficiency-related emphysema[J]. Expert Rev Respir Med, 2015, 9(2):143-151. [15] 苑晓舟, 孟岩, 梁爽, 等. 黏多糖病患者尿液α1-抗胰蛋白酶含量的研究[J]. 生命科学仪器, 2016, 14(12): 47-51. YUAN Xiaozhou, MENG Yan, LIANG Shuang, et al. Study on the content of α1-antitrypsin in mucopolysaccharidosis patients [J]. Life Science Instrument, 2016, 14(12): 47-51. [16] Chen C, Luo M, Ye T, et al. Sensitive colorimetric detection of protein by gold nanoparticles and rolling circle amplification[J]. Analyst, 2015, 140(13): 4515-4520. [17] 张鑫, 赵蕴芝, 许文娟. 尿免疫球蛋白、转铁蛋白、微量白蛋白及β2 -微球蛋白的联合检测对妊娠期高血压疾病的临床价值[J]. 海军医学杂志, 2015, 36(6): 511-513. ZAHNG Xin, ZHAO Yunzhi, XU Wenjuan. Clinical value of combined detection of urinary immunoglobulin, transferrin, microalbumin and β2-microglobulin in hypertensive disorder complicating pregnancy [J]. Journal of Naval Medicine, 2015, 36(6): 511-513. [18] 胡顺金, 汪飞, 胡亚文, 等. 中医药分阶段论治对糖皮质激素治疗原发性肾病综合征疗效的系统评价[J]. 中华中医药杂志, 2014, 29(2): 395-398. HU Shunjin, WANG Fei, HU Yawen, et al. Systematic evaluation of the therapeutic effect of glucocorticoid on primary nephrotic syndrome by stages of traditional Chinese medicine [J]. Chinese Journal of Traditional Chinese Medicine, 2014, 29(2): 395-398. [19] Graterol F, Navarro-Muñoz M, Ibernon M, et al. Poor histological lesions in IgA nephropathy may be reflected in blood and urine peptide profiling[J]. BMC Nephrol, 2013, 14(1): 82. doi: 10.1186/1471-2369-14-82. [20] 张晓丹, 叶剑, 廖玉婷,等.人α1-抗胰蛋白酶在胰岛β细胞移植中免疫抑制和保护作用的研究[J]. 中国病理生理杂志, 2013, 29(4): 619-625. [21] Strandhave C, Svensson M, Krarup H, et al. Haptoglobin genotype and risk markers of cardiovascular disease in patients with chronic kidney disease[J]. Int J Nephrol, 2013, 2013: 650847. doi: 10.1155/2013/650847. [22] 杨俊. 检测尿转铁蛋白对诊断早期妊娠高血压综合征并发肾损害的价值[J]. 检验医学与临床, 2014, 11(21): 3038-3040. YANG Jun. The value of urinary transferrin in the diagnosis of renal damage in early pregnancy induced hypertension syndrome [J]. Laboratory Medicine and Clinical, 2014, 11(21): 3038-3040. [23] 周健, 张茂, 刘德云, 等. 尿微量白蛋白与尿肌酐比值及尿NAG检测在肾结石微创手术中的应用价值[J]. 标记免疫分析与临床, 2016, 23(4): 379-381. ZHOU Jian, ZHANG Mao, LIU Deyun, et al. The value of urinary microalbumin/creatinine ratio and urinary NAG in minimally invasive surgery for renal calculi [J]. Marker Immunoassay and Clinical, 2016, 23(4): 379-381. [24] Bhensdadia NM, Hunt KJ, Lopes-Virella MF, et al. Urine haptoglobin levels predict early renal functional decline in patients with type 2 diabetes[J]. Kidney Int, 2013, 83(6): 1136-1143. [25] Lipska BS, Iatropoulos P, Maranta R, et al. Genetic screening in adolescents with steroid-resistant nephrotic syndrome[J]. Kidney Int, 2013, 84(1): 206-213. |
[1] | 耿二冬,宁涓. 阿替洛尔对急性冠脉综合征合并心律失常患者的临床疗效及预后影响[J]. 山东大学学报 (医学版), 2018, 56(5): 70-73. |
[2] | 张明明,安永辉,韩彩莉,张瑛琪,马明,李娜,邹长鹏. CIK细胞联合光动力治疗中晚期食管癌的疗效观察[J]. 山东大学学报(医学版), 2016, 54(1): 38-41. |
[3] | 樊庆凯, 龚维明, 宁斌, 宋宏亮, 蔚建鲁, 贾堂宏. PKP治疗骨质疏松性多节段椎体压缩性骨折的临床疗效[J]. 山东大学学报(医学版), 2014, 52(11): 73-76. |
[4] | 王秉翔1,聂林1, 蒲华清2,张志勉2. Dynesys动态稳定系统与腰椎后路椎体间融合术术后疗效的Meta分析[J]. 山东大学学报(医学版), 2013, 51(9): 72-78. |
[5] | 李波翰,吴东进,宋杨,张程,赵杰,李德全,张颖哲,马胜忠,高春正. 周围神经吻合后神经生长因子-纤维蛋白胶包埋的临床观察[J]. 山东大学学报(医学版), 2013, 51(7): 58-61. |
[6] | 王美建,侯新国,宋君,周克华,杨俊朋,肖芳,刘继东,邓楠,周晓莹,陈丽. 2型糖尿病患者胰岛素治疗结构化管理模式研究[J]. 山东大学学报(医学版), 2012, 50(10): 1-5. |
[7] | 吴玉生1,刘雪莹1,姜文杰2,张道杰3. 麝香注射液对急性脑梗死患者血单核细胞趋化蛋白-1水平及中性粒细胞CD11b/CD18表达的影响[J]. 山东大学学报(医学版), 2010, 48(6): 111-114. |
|