Clara细胞分泌蛋白检测对急性肾小管坏死诊断的意义

目的：探讨Clara细胞分泌蛋白（CCSP）检测在诊断急性肾小管坏死（ATN）中的意义，以提高ATN的早期诊断率。方法：选取4例ATN患者肾活检组织，以原发性慢性肾小球肾炎[膜性肾病（MN）／微小病变（MCD）n=4]患者的肾脏及4例正常肾组织作为对照，应用免疫组化和免疫荧光方法检测肾脏组织的CCSP表达。选择10例ATN、10例原发性慢性肾小球炎（MN／MCD）和15例正常对照，采用ELISA法测定其血、尿CC16浓度。结果：免疫组化和免疫荧光结果显示,ATN组、MN／MCD组及正常对照组，肾小球中均无CCSP表达，肾小管上皮细胞有CCSP表达。而其中ATN患者则因肾小管受损，其肾小管上皮细胞CCSP表达较另2组下降。ATN患者起病期与肾功能恢复期间尿CC16差异有统计学意义[（1624．45±1119．11）ng／mL比（472．60±289．36）ng／mL，P〈0．01]。尿CC16浓度在ATN起病期显著增高，与正常对照组、MN／MCD组间差异有统计学意义（P〈0．05）。结论：检测肾组织中CCSP有助于判断患者的肾小管功能．特别是近端肾小管受损情况：尿CC16浓度测定可作为急性肾小管损伤的指标，且与受检者肾组织中CCSP表达相吻合。

Diagnostic significance of Clara cell secretion protein in acute renal tubular necrosis

Objective To appraise the value of Clara cell secretion protein （CCSP） for the early detection of acute renal tubular necrosis. Methods Acute renal tubular necrosis （ATN, n=4） patients undergone renal biopsies were selected for study. Biopsy specimens of primary chronic glomerulonephritis [primary membranous nephropathy （MN） or minimal change disease （MCD） （n=4）] were obtained and normal kidney（n=4） biopsy specimens obtained from kidney donors for transplantion were served as controls. Expression of CCSP in renal tissue was detected by immunohistochemistry and immunofluorescence. CC16 （Clara cell secretion protein 16） levels in blood and urine were determined by ELISA in ATN patients （n=10）, primary chronic glomerulonephritis patients （n=10） and healthy controls （n=15）. Results No CCSP expression was found in glomeruli but was seen in tubular epithelial cells of of all these three groups （normal controls, MN/MCD group, ATN patients）. CCSP was down-regulated in ATN because of injuries of renal tubule. Urine levels of CC16 at onset and recovery period of ATN differed significantly （P〈0.01）. Urine level of CC16 at onset of ATN increased obviously, significantly higher than that of MN/MCD group and normal controls （P〈0.05）. Conclusions Detection of CCSP in renal tissue might help the judgment of injuries of renal tubule, especially proximal renal tubule. Urinary, CC16 level could be used as a marker of acute renal tubular injuries, and is correlated with expression of CCSP in renal tissues.