摘要
目的比较儿童IgM肾病（IgMN）和IgA肾病（IgAN）的临床表现、病理损伤及尿蛋白标志物水平变化，探讨尿蛋白标志物对IgAN和IgMN患儿肾脏病理损伤严重程度的预测价值。方法选择2002年1月至2014年10月行肾组织活检的74例患儿为研究对象。检测活检当日晨尿中IgG、清蛋白（Alb）、转铁蛋白（TRF）、α1-微球蛋白（α1-MG）、β2-微球蛋白（β2-MG）和N·乙酰-β-葡萄糖苷酶（NAG）水平。采用系膜细胞增生（MC）、肾小球硬化（GS）、肾小管问质损伤（TID）的评分半定量评估肾脏病理损伤严重程度。以多因素Logistic回归分析评估在校正混杂因素后尿液蛋白与肾脏病理损伤的关系，用受试者工作特征曲线下面积（AUC）评价尿液蛋白对肾脏病理损伤严重程度的预测价值。结果74例患儿中，IgAN44例，IgMN30例。IgAN患儿尿α1-MG和Alb水平高于IgMN患儿；然而，校正年龄后，差异无统计学意义。多因素Logistic回归分析显示，尿液蛋白中TRF与IgAN和IgMN患儿严重MC（〉5个系膜细胞／系膜区）显著相关（B=0．010）；Alb与严重GS（≥10％肾小球节段性黏连或硬化）显著相关（B=0．001）；NAG与严重TID（局灶或弥散性肾小管间质病变）显著相关（B=0．038）。尿β2-MG与严重MC、GS、TID无显著相关。尿TRF预测严重MC的AUC值为0．85（P〈0．001）。尿Alb预测严重GS的AUC值为0．78（P=0．002）。尿NAG预测严重TID的AUC值为0．78（P=0．003）。结论尿蛋白标志物是预测儿童IgAN和IgMN肾脏病理损伤严重程度的指标。其中尿TRF、Alb和NAG具有更好的预测价值。
Objective To compare the clinical manifestations,renal histological lesions, and the levels of uri- nary protein markers between the children with IgA nephropathy （IgAN） and those with IgM nephropathy （IgMN） , and to determine whether urinary protein markers could predict the severity of renal histological lesions in children with IgAN and IgMN. Methods Seventy - four children with renal biopsy - proven IgAN and IgMN from January 2002 to October 2014 were enrolled in the study. The levels of IgG, albumin （Alb）, transferrin （TRF）, α1 -microglobnlin （α1 - MG） ,β2 - mieroglobulin （ β2 - MG） and N - acetyl - 13 - glucosaminidase （NAG） in morning urine samples before biopsy were measured. The semi - quantitative scores of mesangial hypereellularity （ MC ） , glomeruloselerosis （GS）, and tubule -interstitial damage （TID） were used to assess renal histological lesions. Multivariate Logistic regression analysis was used to determine whether urinary protein levels were independently associated with renal histological lesions. The area under the receiver - operating - characteristic curve （AUC） was calculated to assess the predictive a- bility of urinary protein markers. Results Seventy - four children （44 cases with IgAN,30 cases with IgMN） were included. The urinary levels of ct, - MG and Alb were significantly higher in children with IgAN as compared to those with IgMN. The differences, however, did not remain significant after adjustment for age. The urine protein, as an independent factor associated with severe MC （ 〉 5 rnesangial cells per mesangial area） was TRF（ B = 0. 010 ） , and severe GS （ ≥ 10% glomeruli showing segmental adhesion or sclerosis） was significantly correlated with Alb（B =0.001 ） ,and severe TID （focal or diffuse tubular and interstitial lesions） was significantly correlated with NAG（ B = 0.038 ）. Urinary 132 - MG was not significantly associated with severe MC, GS and TID. Urinary TRF, Alb and NAG achieved the best AUC of 0.85 （P 〈0. 001 ） ,0.78 （P =0. 002） ,and 0.78 （P =0.003） ,respectively,for predicting severe MC,GS,and TID. Conclusions Urinary proteins are useful to predict the severity of renal histological lesions in children with IgAN and lgMN. Urinary TRF, Alb and NAG have better predictive value.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2015年第17期1321-1324,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
国家自然科学基金（81370773）
江苏省自然科学基金（BK2012604）
江苏省教育厅面上项目（12KJB320006）
关键词
尿蛋白标志物
IGA肾病
IGM肾病
肾脏病理损伤
预测价值
Urinary protein markers
IgA nephropathy
IgM nephropathy
Renal histological lesions
Predictive value
