原发性肾病综合征患者中性粒细胞明胶酶相关脂质运载蛋白的变化及意义

目的 探讨原发性肾病综合征(PNS)患者中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的变化以及与病理类型、肾小管间质损伤程度、临床指标的关系. 方法 40例PNS患者按有无急性肾小管坏死(ATN)分急性肾损伤(AKI)组及非AKI组,按病理类型分微小病变型肾病(MCD)组、系膜增生性肾小球肾炎(MsPGN)组、局灶性节段性肾小球硬化(FSGS)组、膜增生性肾小球肾炎(MPGN)组、膜性肾病(MN)组；20例健康体检者及20例因肾肿瘤做肾切除术但远离肿瘤部位的正常肾组织作正常对照.采用酶联免疫吸附试验(ELISA)法检测血清、尿液NGAL水平,免疫组织化学染色法观察肾组织NGAL表达.结果 (1) AKI组患者血、尿NGAL水平及肾组织NGAL表达显著高于非AKI组及对照组(P＜0.05).(2)MPGN组及FSGS组患者血、尿NGAL水平及肾组织NGAL表达显著高于其他病理类型组(P＜0.05).(3)在肾小管间质发展至重度病变之前,随着肾小管间质损伤程度的加重,血、尿NGAL水平及肾组织NGAL表达逐渐升高；在肾小管间质发展至重度病变时,血NGAL水平及肾组织NGAL表达下降(P＜0.05).(4)血、尿NGAL水平及肾组织NGAL表达与血肌酐呈正相关(r值分别为0.198、0.352、0.146,P值分别为0.048、0.000、0.028),与尿素氮呈正相关(r值分别为0.199、0.278、0.325,P值分别为0.043、0.000、0.019),与血白蛋白呈负相关(r值分别为-0.384、-0.318、-0.259,P值分别为0.028、0.024、0.020),与尿渗透浓度呈负相关(r值分别为-0.250、-0.256、-0.277,P值分别为0.012、0.027、0.002).结论 NGAL可作为预测PNS患者AKI的敏感指标,在一定程度下可用于评价肾小管间质病变程度及肾功能.

The Change and significance of neutrophil gelatinase-associated lipocalin in patients with primary nephrotic syndrome

Objective To discuss the changes of neutrophil gelatinase - associated lipocalin (NGAL) in patients with primary nephrotic syndrome（PNS）and the correlation with renal pathological type, renal tubulointerstitial lesions and the clinical indicators. Methods Forty patients with PNS were divided into acute kidney injury (AKI) group and non - AKI group according to whether renal tubular necrosis（ATN） occurred in renal pathology. Moreover, on the basis of pathological type they were divided into minimal change disease (MCD) group, mesangial proliferative glomerulonephritis (MsPGN) group, focal segmental glomerulosclerosis (FSGS) group, membrane proliferative glomerulonephritis (MPGN) group and membranous nephropathy (MN) group. Twenty healthy subjects and normal kidney tissues which came from 20 patients with renal tumor nephrectomy and were distant from the tumor sites were the control groups. Enzyme-linked immunosorbent assay (ELISA) was applied to detect the serum and urine level of NGAL, and immunohistochemical staining was used to observe the expression of NGAL in the renal tissue. Results (1)The serum and urine level of NGAL and the expression of NGAL in the renal tissue in the PNS complicated with AKI group were significantly higher than that in the PNS without AKI group and in the control group(P＜0.05). (2)The serum and urine level of NGAL and the expression of NGAL in the renal tissue were enhanced in MPGN group and FSGS group than that in the other three groups(P＜0.05). (3) Before developing to severe tubulointerstitial lesions, with the aggravation of tubulointerstitial damage, the serum and urine level of NGAL and the expression of NGAL in the renal tissue were increased. But when renal tubular interstitial lesions developed to severe disease, serum level of NGAL and the expression of NGAL in the renal tissue were decreased(P＜0.05). (4)The serum and urine level of NGAL and the expression of NGAL in the renal tissue were positively correlated with serum creatinine(r values were 0.198, 0.352, 0.146 respectively, P values were 0.048, 0.000, 0.028 respectively), were positively correlated with blood urea nitrogen(r values were 0.199, 0.278, 0.325 respectively, P values were 0.043, 0.000, 0.019 respectively), were negatively correlated with serum albumin(r values were -0.384, -0.318, -0.259 respectively, P values were 0.028, 0.024, 0.020 respectively) and were negatively correlated with urine osmotic pressure(r values were -0.250, -0.256, -0.277 respectively, P values were 0.012, 0.027, 0.002 respectively). Conclusion NGAL is a sensitive biological parameter for predicting AKI in the patients with PNS, and it can be used to evaluate the degree of tubulointerstitial lesions and renal function to a certain extent.