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目的检测过敏性紫癜(HSP)患儿尿中中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿胱抑素C(Cys C)、尿β2-微球蛋白(β2-MG)水平及24 h尿蛋白定量,探讨尿NGAL、Cys C在检测HSP患儿肾小管间质损伤中的临床意义。方法选择临床诊断为HSP的患儿60例。根据24 h尿蛋白定量将患儿分为尿检未见异常组(A组,20例)、尿检轻度异常组(B组,20例)、尿检重度异常组(C组,20例)、治疗后病情好转组(D组,15例,均为C组治疗后患儿)。选取在本院儿童保健门诊体检健康儿童20例为健康对照组。其中15例患儿(B组5例,C组10例)行肾脏病理检查,并对肾小管间质进行病理评分。30例患儿(B组10例,C组20例)行尿蛋白电泳检查。设立尿NGAL、Cys C、β2-MG的正常参考值上限,高于此值者视为异常,并计算异常率。结果 1.A、B、C组尿NGAL及Cys C水平升高,且呈递增趋势;D组尿NGAL水平与健康对照组比较无明显差异,尿Cys C水平较B组降低,但高于健康对照组。2.B组尿NGAL的异常率高于尿β2-MG,尿Cys C的异常率与尿β2-MG比较无明显差异;D组尿β2-MG的异常率高于尿NGAL。3.尿NGAL、Cys C、β2-MG水平与肾小管间质病理评分、尿蛋白电泳结果均呈正相关(r=0.638、0.471;0.661、0.321;0.405、0.342,Pa<0.05)。C组患儿肾小管间质病例评分、尿蛋白电泳(小管性)结果均高于B组(Pa<0.05)。结论尿NGAL、Cys C可作为监测HSP患儿早期肾小管间质损伤的指标,具有较高的灵敏度和特异性,优于传统指标尿β2-MG。
Objective To detect the levels of urinary neutrophil gelatinase-associated lipocalin (NGAL), urine Cys C and β2-microglobulin (β2-MG) in children with Henoch-Schonlein purpura (HSP) 24 h urinary protein, urinary NGAL, Cys C in the detection of renal tubulointerstitial injury in children with clinical significance. Methods Sixty children with clinical diagnosis of HSP were selected. According to the 24 h urinary protein, the children were divided into two groups: no abnormal group (A group, 20 cases), mild urinalysis group (group B, 20 cases), severe urinalysis group (C group, 20 cases) After the condition improved group (D group, 15 cases, both C group after treatment in children). Selected in our hospital child health check-ups of healthy children 20 cases of healthy control group. Among them, 15 cases (5 cases in group B and 10 cases in group C) underwent pathological examination of renal pathology and pathological score of tubulointerstitium. Thirty patients (10 in group B and 20 in group C) were examined by urinary protein electrophoresis. Urine NGAL, Cys C, β2-MG set the upper limit of normal reference, higher than this value were considered as abnormal, and calculate the abnormal rate. Results 1. The levels of NGAL and Cys C were increased in groups A, B and C, and showed an increasing trend. The levels of urinary NGAL in group D were not significantly different from those in healthy controls, but were lower than those in group B Control group. The abnormal rate of urine NGAL in group B was higher than that of urine β2-MG. The abnormal rate of urine Cys C had no significant difference with that of urine β2-MG. The abnormal rate of urine β2-MG in group D was higher than that of urine NGAL. Urinary NGAL, Cys C, β2-MG levels were positively correlated with tubulointerstitial pathological score and urine protein electrophoresis (r = 0.638,0.471; 0.661,0.321; 0.405,0.342, Pa <0.05). The scores of tubulointerstitial and urine protein electrophoresis (tubule) in group C were higher than those in group B (P <0.05). Conclusion Urine NGAL and Cys C can be used as indicators of early tubulointerstitial injury in children with HSP, which has higher sensitivity and specificity than urinary β2-MG.