MsPGN与FSGS患者血清Angptl 4、suPAR改变及其临床意义

目的 观察系膜增生性肾小球肾炎（MsPGN）与局灶节段性肾小球硬化（FSGS）患者血管生成素样蛋白-4（Angptl-4）及可溶性尿激酶型纤溶酶原激活物受体（suPAR）血清水平改变，并探讨其临床意义。方法 选取2015年3月~2016年10月经皮肾穿刺活检患者120例（观察组），其中MsPGN 66例，FSGS 54例；另取同期健康体检者120例（对照组）。分别比较观察组水肿与蛋白尿的严重程度、血清白蛋白水平与相应的血清Angptl-4、suPAR水平、FSGS行肾移植后复发者与未复发者血清suPAR水平。结果 观察组血清Angptl-4、suPAR水平显著高于对照组，Angptl-4、suPAR水平随尿蛋白增加升高，与血清白蛋白呈负相关，MsPGN患者血清Angptl-4水平显著高于FSGS患者，而FSGS患者血清suPAR水平显著高于MsPGN患者，且FSGS肾移植后复发患者血清suPAR水平显著高于未复发者，上述差异均有统计学意义（P均<0.05）。结论 Angptl-4、suPAR水平在MsPGN与FSGS的发生和发展中具有不同病理作用，血清suPAR水平可能作为预测FSGS患者肾移植后复发风险的生物学标志物。

Alteration and Clinical Significance of Serum Angptl-4 and suPAR in MsPGN and FSGS Patients

Objective To observe the lteration and clinical significance of serum Angptl-4 and suPAR in patients with mesangial proliferative glomerulonephritis (MsPGN) and focal segmental glomerulosclerosis (FSGS).Methods Totally 120 cases, hospitalized from March 2015 to October 2016 and receiving percutaneous renal biopsy were selected as the observation group, in which MsPGN 66 cases and FSGS 54 cases. Another 120 healthy physical examination cases in the same period were selected as control group. The degree of edema and proteinuria, serum albumin level, serum Angptl-4 and suPAR levels were compared, and the level of serum suPAR in patients with recurrent and non-recurrent FSGS after renal transplantation were also compared.Results The levels of serum Angptl-4 and suPAR in observation group were significantly higher than those of control group. Serum Angptl-4 and suPAR levels were elevated with the increase of urinary protein, and were negatively correlated with serum albumin concentration. Serum Angptl-4 level in patients with MsPGN was significantly higher than that of FSGS patients, while serum suPAR levels in patients with FSGS was significantly higher than that of patients with MsPGN. Serum suPAR level in recurrent FSGS patients after renal transplantation was significantly higher than those in non-recurrenct FSGS patients. All the differences were statistically significant (P<0.05).Conclusion The levels of serum Angptl-4 and suPAR had different pathological roles in the occurrence and development of MsPGN and FSGS, and the serum suPAR level may be used as a biomarker to predict the risk of recurrence after transplantation in FSGS patients.