过敏性紫癜患儿尿中中性粒细胞明胶酶相关脂质运载蛋白、尿胱抑素C水平测定及其意义

目的 检测过敏性紫癜(HSP)患儿尿中中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿胱抑素C(Cys C)、尿β<,2>-微球蛋白(β<,2>-MG)水平及24 h尿蛋白定量,探讨尿NGAL、Cys C在检测HSP患儿肾小管间质损伤中的临床意义.方法 选择临床诊断为HSP的患儿60例.根据24 h尿蛋白定量将患儿分为尿检末见异常组(A组,20例)、尿检轻度异常组(B组,20例)、尿检重度异常组(C组,20例)、治疗后病情好转组(D组,15例,均为C组治疗后患儿).选取在本院儿童保健门诊体榆健康儿章20例为健康对照组.其中15例患儿(B组5例,C组10例)行肾脏病理检查,并对肾小管间质进行病理评分.30例患儿(B组10例,C组20例)行尿蛋白电泳检查.设立尿NGAL、Cys C、β<,2>-MG的正常参考值上限,高于此值者视为异常,并计算异常率.结果 1.A、B、C组尿NGAL及Cys C水平升高,且呈递增趋势;D组尿NGAL水平与健康对照组比较无明显差异,尿Cys C水平较B组降低,但高于健康对照组.2.B组尿NGAL的异常率高于尿β<,2>-MG,尿Cys C的异常率与尿β<,2>-MG比较无明显差异;D组尿β<,2>-MG的异常率高于尿NGAL.3.尿NGAL、Cys C、β<,2>-MG水平与肾小管间质病理评分、尿蛋白电泳结果均呈正相关(r=0.638、0.471;0.661、0.321;0.405、0.342,P<,a><0.05).C组患儿小管间质病例评分、尿蛋白电泳(小管性)结果均高于 B组(P<,a><0.05).结论 尿NGAL、Cys C可作为监测HSP患儿早期肾小管间质损伤的指标,具有较高的灵敏度和特异性,优于传统指标尿β<,2>-MG.

Detection and Value of Levels of Urinary Neutrophil Gelatinase Associated Lipocalin and Urinary Cystatin C in Children with Henoch-Schonlein Purpura

Objective To explore the significance of urinary neutrophil gelatinase associated lipocalin(NGAL) and urinary Cystatin C(Cys C) in renal tubulointerstitial damage by investigating the levels of urinary NGAL,urinary Cys C,urinary β2-microglobulin(MG) and 24 hours urine total protein(UTP/24 h) in children with Henoch-Schonlein purpura(HSP).Methods Sixty patients who had been diagnosed as HSP and 20 healthy children as the healthy control group were included.Based on the UTP/24 h,the HSP children were divided into 4 groups:the normal urine protein(group A,n=20),the micro urine protein(group B,n=20),the macro urine protein(group C,n=20),the alleviated period(group D,n=15,the patients from group C).Fifteen out of the above 60 patients received renal biopsy,5 cases from group B and 10 cases from group C.Renal tubulointerstitum lesions were scored.Thirty patients(10 cases from group B and 20 cases from group C) received urine protien electrophoresis analysis.The abnormal rates of urinary NGAL,Cys C and β2-MG were calculated according to the upper limit of the range of them.Results 1.The concentration of urinary NGAL and urinary Cys C in group A,B and C increased gra-dually;There was no significant difference between group D and the healthy control group in urinary NGAL.The level of urinary Cys C in group D was lower than that in group B,but it was higher than that in the healthy control group.2.The abnormal rate of urinary NGAL in group B was higher than that of urinary β2-MG,but there was no significant difference between urinary Cys C and urinary β2-MG in the abnormal rates.The abnormal rate of urinary β2-MG in group D was higher than that of urinary NGAL.3.The levels of urinary NGAL,Cys C and β2-MG were positively correlated with the score of renal tubulointerstitum lesions and the result of urine protien electrophoresis analysis(r=0.638,0.471;0.661,0.321;0.405,0.342,Pa<0.05).The score of renal tubulointerstitum lesions and the result of urine protien electrophoresis analysis in group C were different from those in group B(Pa<0.05).Conclusion It is suggested that urinary NGAL and urinary Cys C can be used as early index in assessing the renal tubulointerstitial damage in patients with HSP,which are more sensitive and peculiar than traditional index.