肾损伤分子-1对儿童紫癜性肾炎伴急性肾损伤早期诊断的意义

doi:10.3877/cma.j.issn.1673-5250.2016.05.006

目的

探讨肾损伤分子(KIM)-1对儿童紫癜性肾炎(HSPN)伴急性肾损伤(AKI)早期诊断的临床意义。

方法

选择2010年1月至2016年1月，在广州市第一人民医院儿童肾脏科住院的100例HSPN(肾病综合征型)患儿为研究对象。按照是否存在AKI，将受试者分为HSPN伴AKI组和HSPN组，每组各50例。留取两组患儿的血、尿标本进行血肌酐、24 h尿蛋白定量等相关实验室检查，并采用酶联免疫吸附测定(ELISA)法检测患儿血清、尿KIM-1含量；对两组各10例自愿行肾脏穿刺活检术患儿的肾脏标本，采用免疫组化法检测KIM-1在患儿肾脏的表达及部位。两组患儿年龄和体重比较，差异无统计学意义(P>0.05)。所有受试者的监护人均签署自愿参加实验的知情同意书，并通过病例收集医院伦理委员会的伦理评审。

结果

①HSPN伴AKI组患儿血清肌酐、胱抑素(Cys)C，以及血清和尿β₂-微球蛋白(MG)与KIM-1水平，均显著高于HSPN组患儿，而血红蛋白(Hb)、血清白蛋白及肾小球滤过率(GFR)，则显著低于HSPN组患儿，且差异均有统计学意义(P<0.05)。两组患儿24 h尿蛋白定量比较，差异无统计学意义(P>0.05)。②肾脏穿刺组织行免疫组化染色显示，HSPN组未见明显棕黄色颗粒表达，染色浅；而HSPN伴AKI组棕黄色颗粒多，染色深，主要表达在肾小管上皮细胞。

结论

血清、尿KIM-1含量检测，有助于早期诊断儿童HSPN伴AKI。

关键词: HAVCR1蛋白，人类, 急性肾损伤, 紫癜，过敏性, 儿童

Objective

To evaluate the clinical significance of kidney injury molecules (KIM)-1 in early diagnosis of children with Henoch-Schonlein purpura nephritis(HSPN) and acute kidney injury(AKI).

Methods

A total of 100 cases of HSPN children (nephrotic syndrome type) in Guangzhou First People′s Hospital from January 2010 to January 2016, who were chosen as study objects. According to suffered by AKI or not, they were divided into HSPN with AKI group and HSPN group, 50 cases in each group. Blood and urine samples were collected of two groups of children for related laboratory tests, such as serum and urine creatinine, 24 h urine protein quantitative etc., using enzyme-linked immunosorbent assay(ELISA) method to detect the contents of serum and urine KIM-1. For the 10 cases of voluntary kidney biopsy children in each group, their kidney specimens were using immunohistochemical method to detect KIM-1 expression and distribution in the children′s kidney tissue. There were no significant differences between two groups of children in age and weight(P>0.05). All the subjects′ parents signed the informed consents of volunteered for the experiment, and was approved by the Ethical Review Board of Investigation in Human Being of Guangzhou First People′s Hospital.

Results

①The levels of serum creatinine, serum cystatin(Cys) C, serum and urine β₂-microglobulin(MG), and serum and urine KIM-1 of children in HSPN with AKI group were higher than those of HSPN group, but, the hemoglobin(Hb), serum albumin and glomerular filtration rate(GFR) were lower than those of HSPN group, and the differences were statistically significant(P<0.05). There was no significant difference between two groups in 24 h urine protein quantitative(P>0.05). ② The immunohistochemical staining of renal biopsy showed that there was no obvious tan particles expression in HSPN group, and staining shallow; However, tan particles were more, deep dyeing, and mainly expressed in renal tubular epithelial cells in HSPN with AKI group.

Conclusions

The serum and urine KIM-1 content detection is helpful for the early diagnosis of HSPN children with AKI.

Key words: HAVCR1 protein, human, Acute kidney injury, Purpura, Schoenlein-Henoch, Child

表1 两组患儿各临床指标比较(±s)

组别	例数	年龄(岁)	体重(kg)	Hb (g/L)	血清肌酐(μmol/L)	血清CysC (mg/L)	血清白蛋白(g/L)
HSPN伴AKI组	50	9.6±1.5	29.8±10.3	120.4±5.9	90.3±16.5	2.7±0.5	33.0±4.5
HSPN组	50	9.5±1.8	32.6±11.5	123.9±6.7	45.3±11.9	0.8±1.4	35.7±4.5
t值	?	1.361	1.210	5.970	8.217	8.213	2.640
P值	?	0.065	0.234	0.000	0.000	0.000	0.015
组别	例数	血清β₂-MG (mg/L)	尿β₂-MG (mg/L)	GFR (mL/min)	尿蛋白(g/d)	血清KIM-1 (ng/L)	尿KIM-1 (ng/L)
HSPN伴AKI组	50	5.4±3.6	15.1±17.5	65.4±11.8	3.3±1.4	146.2±68.1	331.2±56.3
HSPN组	50	1.7±0.3	0.6±0.4	125.5±8.2	3.9±1.7	9.3±1.5	17.2±9.1
t值	?	5.640	2.920	14.310	0.242	8.526	8.146
P值	?	0.000	0.007	0.000	0.790	0.000	0.000

表1 两组患儿各临床指标比较(±s)

组别	例数	年龄(岁)	体重(kg)	Hb (g/L)	血清肌酐(μmol/L)	血清CysC (mg/L)	血清白蛋白(g/L)
HSPN伴AKI组	50	9.6±1.5	29.8±10.3	120.4±5.9	90.3±16.5	2.7±0.5	33.0±4.5
HSPN组	50	9.5±1.8	32.6±11.5	123.9±6.7	45.3±11.9	0.8±1.4	35.7±4.5
t值	?	1.361	1.210	5.970	8.217	8.213	2.640
P值	?	0.065	0.234	0.000	0.000	0.000	0.015
组别	例数	血清β₂-MG (mg/L)	尿β₂-MG (mg/L)	GFR (mL/min)	尿蛋白(g/d)	血清KIM-1 (ng/L)	尿KIM-1 (ng/L)
HSPN伴AKI组	50	5.4±3.6	15.1±17.5	65.4±11.8	3.3±1.4	146.2±68.1	331.2±56.3
HSPN组	50	1.7±0.3	0.6±0.4	125.5±8.2	3.9±1.7	9.3±1.5	17.2±9.1
t值	?	5.640	2.920	14.310	0.242	8.526	8.146
P值	?	0.000	0.007	0.000	0.790	0.000	0.000

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Clinical significance of kidney injury molecule-1 for early diagnosis of children with purpura nephritis and acute kidney injury

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Clinical significance of kidney injury molecule-1 for early diagnosis of children with purpura nephritis and acute kidney injury