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目的检测中性粒细胞明胶酶相关运载蛋白(NGAL)在过敏性紫癜(HSP)患儿肾组织中的表达及血清和尿中的水平,并评价其临床意义。方法将81例HSP患儿按照尿白蛋白排泄率(UAER)分成正常白蛋白尿组(A组,n=38)、微量白蛋白尿组(B组,n=26)和大量白蛋白尿组(C组,n=17),并与健康对照儿童进行比较(D组,n=35),采用双抗体夹心ELISA方法检测4组儿童血清和尿NGAL;其中22例患儿于急性期行经皮肾穿刺活检(A组5例,B组9例,C组8例)均行光镜和免疫荧光检查,采用免疫组织化学SABC法检测肾组织NGAL的表达。结果与D组比较,A组和B组血清NGAL变化无意义(P>0.05),C组血清NGAL显著增高(P<0.05);各组HSP患儿尿NGAL水平均升高,且呈递增趋势(P<0.05);肾组织病理形态学结果显示,22例患儿均表现为不同程度的系膜增殖,按ISKDC标准分型,A组:Ⅰ级1例、Ⅱa 4例;B组:Ⅱa 2、Ⅱb 4例、Ⅲa 3例;C组:Ⅲa 2例、Ⅲb 6例。免疫组织化学检测结果显示,在正常的肾组织中仅有少量或无NGAL的表达,而在HSP患儿肾组织中均有明显表达,且A、B、C组呈递增趋势(P<0.05);相关分析显示,尿NGAL与肾组织NGAL的表达呈正相关(r=0.604,P<0.05)。结论NGAL与HSP的发生发展有关。尿NGAL水平的检测对紫癜性肾炎的早期诊断具有重要价值,且对判断HSP肾脏受累的程度具有重要指导作用。
Objective To detect the expression of neutrophil gelatinase-associated transporter (NGAL) in renal tissues of children with Henoch-Schonlein purpura (HSP) and its serum and urinary levels and to evaluate its clinical significance. Methods 81 cases of HSP were divided into normal albuminuria group (group A, n = 38), microalbuminuria group (group B, n = 26) and a large amount of albuminuria group according to urinary albumin excretion rate (UAER) (Group C, n = 17), and compared with healthy control children (group D, n = 35). Serum and urinary NGAL were detected in 4 groups of children by double antibody sandwich ELISA. Twenty-two of these children underwent percutaneous Kidney biopsy (5 cases in group A, 9 cases in group B and 8 cases in group C) were examined by light microscopy and immunofluorescence. The expression of NGAL in renal tissues was detected by immunohistochemical SABC method. Results Compared with group D, the changes of serum NGAL in group A and group B were insignificant (P> 0.05), while the level of serum NGAL in group C was significantly higher (P <0.05). The level of urinary NGAL in group HSP was higher (P <0.05). Pathomorphology of renal tissue showed that all of the 22 cases showed mesangial proliferation in different degrees. According to ISKDC standard classification, group A was grade Ⅰ in 1 case and case Ⅱa in 4 cases. Group B: Ⅱ a 2, Ⅱ b 4 cases, Ⅲ a 3 cases; C group: Ⅲ a 2 cases, Ⅲ b 6 cases. Immunohistochemical results showed that there was only a small amount or no expression of NGAL in normal kidney tissues, but significant in kidney tissues of HSP children, and the increasing trend in A, B and C groups (P <0.05) The correlation analysis showed that there was a positive correlation between urinary NGAL and NGAL expression in renal tissues (r = 0.604, P <0.05). Conclusion NGAL is related to the occurrence and development of HSP. Detection of urinary NGAL levels is of great value in the early diagnosis of purpura nephritis and plays an important guiding role in judging the extent of HSP kidney involvement.