尿微量蛋白分类定量分析对系统性红斑狼疮早期肾损害诊断的意义及免疫调节治疗对其影响

目的　本研究旨在探讨系统性红斑狼疮 (SLE)患者尿中不同种微量蛋白的改变对早期诊断肾脏损害的意义及免疫调节治疗对其影响。方法　应用酶联免疫法定量分析 2 0例健康志愿者及 5 2例SLE患者 (尿常规检查尿蛋白阴性组和阳性组 )免疫调节治疗前后尿中视黄醇结合蛋白 (RBP)、白蛋白 (ALB)、转铁蛋白 (TRF)及免疫球蛋白G(IgG)的变化。结果　SLE尿蛋白阴性组患者尿中RBP、ALB、TRF、IgG含量分别升高到健康对照组的 19 8、30 9、19 5、5 5倍 ,尿蛋白阳性组患者尿中RBP、ALB、TRF、IgG分别升高到正常组的 10 5 7、2 10 8、135 5、31 5倍。两组间差异显著(P <0 0 0 1)。治疗后两组患者尿微量蛋白量均较治疗前明显下降 ,SLE尿蛋白阴性组下降的幅度较大 ,RBP、ALB、TRF、lgG分别下降了 4 0 1%、4 9 8%、6 8 8%、80 6 %。而尿蛋白阳性组下降的幅度比前者略小 ,四种蛋白分别下降了31 5 %、4 9 5 %、4 0 4 %、4 2 2 %。结论　SLE患者在临床诊断为狼疮肾炎之前 ,尿蛋白量已明显增加 ,尿RBP、ALB、TRF及IgG升高 ,提示肾小管及肾小球功能均受损 ,其中以ALB升高最明显。因此 ,ALB、RBP可作为早期诊断LN较为敏感的指标。早期治疗SLE肾损害疗效较为明显 ,尿TRF及ALB可作为较为敏感的疗效观察指标。

The importance of urine protein quantitative analysis on the early diagnosis of lupus nephritis and their immuno-regulatory therapy

Objective To detect micro proteinuria of RBP, ALB, TRF and lgG in systemic lupus erythematosus(SLE) patients before and after immunoregulatory therapy for evaluating the importance on early diagnosis of lupus nephritis and observation of therapeutic effect in SLE. Methods Applying ELISA method to detect and quantitatively analyze the proteinuria of RBP, ALB. TRF and IgG of 20 healthy volunteers and 52 SLE patients with proteinuria negative group and positive group in urine routine test. Results Proteinuria of RBP ALB, TRF, IgG in SLE patients with negative urine routine test were increased respectively to 19 8, 30 9, 19 5, 5 5 folds of healthy control. They were increased to 105 7, 210 8, 135 5 and 31 5 folds respectively in group with proteinuria positive in urine routine test. After therapy, the former showed that proteinuria of RBP, ALB, TRF and IgG decerased 40 1%, 49 8%, 68 8%, 80 6% respectively; the later decreased 31 5%, 49 5%, 40 4%, 42 2%, respectively. A statistic difference was showed between the two groups. Conclusion proteinuria was already increased before development of lupus nephritis. The elevated urine RBP ALB, TRF, IgG level suggests glomerular and tubular involvement. RBP and ALB can be used as predictors in early diagnosis of SLE kidney damage. Early therapy may get better effect, TRF and ALB can act as predictors of therapeutic effect.