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目的:探讨原发性及狼疮性肾病综合征患者纤溶酶原激活物抑制因子1(PAI-1)和血清脂蛋白a[Lp(a)]的水平变化及其检测的临床应用价值。方法:选取病理类型明确,临床初诊为肾病综合征的患者138例。其中原发性肾病综合征70例,为PNS组;系统性红斑狼疮继发性肾病综合征患者68例,为LNS组。同期选取本院健康体检正常者64例,为正常对照NC组。全自动生化分析仪检测各组血清Lp(a)和血脂等指标;酶联免疫吸附(Elisa)法测定血清PAI-1水平。结果:1与NC组比较,血清Lp(a)和PAI-1水平在PNS和LNS两组中均显著升高(P<0.05),PNS组比LNS组升高更为明显,差异有统计学意义(P<0.05);2LP(a)与PAI-1秩相关系数(rs)分析,在PNS组中r_s=0.328,P=0.006,LNS组中r_s=0.439,P=0.006;3二元logistic回归分析表明,LP(a)和PAI-1均是PNS和LNS的危险因素;4ROC曲线分析表明,血清Lp(a)、PAI-1对PNS和LNS诊断的ROC曲线下面积(AUC~(ROC))分别为0.895、0.874和0.848、0.813,两者联合检测对PNS和LNS诊断的AUC~(ROC)分别为0.947和0.919。结论:血清Lp(a)与PAI-1水平在PNS和LNS患者体内均明显升高,PNS患者升高更为显著;Lp(a)与PAI-1水平在PNS和LNS患者中均显著正相关;LP(a)和PAI-1均是PNS和LNS的危险因素,两者水平的变化与PNS和LNS的发生相关。联合检测Lp(a)与PAI-1水平对PNS和LNS的诊治具有一定的临床应用价值。
Objective: To investigate the changes of plasminogen activator inhibitor 1 (PAI-1) and serum lipoprotein (a) [Lp (a)] in patients with primary and lupus nephrotic syndrome and its clinical value. Methods: A total of 138 patients with newly diagnosed nephrotic syndrome were enrolled in the study. The primary nephrotic syndrome in 70 cases, PNS group; 68 cases of systemic lupus erythematosus secondary nephrotic syndrome, LNS group. In the same period, 64 normal subjects in our hospital were selected as normal control group. Serum levels of Lp (a) and serum lipids were detected by automatic biochemical analyzer. Serum PAI-1 level was measured by Elisa method. Results: 1 Compared with NC group, the levels of serum Lp (a) and PAI-1 in both PNS and LNS groups were significantly increased (P <0.05), PNS group was more obvious than LNS group, the difference was statistically significant (R = 0.328, P = 0.006, r_s = 0.439, P = 0.006); 3 Binary logistic regression analysis (P <0.05) Regression analysis showed that both LP (a) and PAI-1 were risk factors for PNS and LNS. 4ROC curve analysis showed that the area under the curve of ROC (AUC ~ (ROC) )) Were 0.895,0.874 and 0.848,0.813, respectively. The AUC ROC of the combined detection of PNS and LNS were 0.947 and 0.919, respectively. Conclusions: The levels of serum Lp (a) and PAI-1 in patients with PNS and LNS are significantly higher than those in patients with PNS and elevated more significantly in patients with PNS. Lp (a) and PAI-1 levels are positively correlated with PNS and LNS ; Both LP (a) and PAI-1 were risk factors of PNS and LNS. The changes of both levels correlated with the occurrence of PNS and LNS. Combined detection of Lp (a) and PAI-1 levels has some clinical value in the diagnosis and treatment of PNS and LNS.