中性粒细胞明胶酶相关脂质运载蛋白可区分特发性肾病综合征的激素敏感性。
NGAL distinguishes steroid sensitivity in idiopathic nephrotic syndrome.
机构信息
Division Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7022, Cincinnati, OH 45229, USA.
出版信息
Pediatr Nephrol. 2012 May;27(5):807-12. doi: 10.1007/s00467-011-2075-7. Epub 2011 Dec 27.
BACKGROUND
Idiopathic nephrotic syndrome (NS) is the most common glomerular disorder of childhood. Invasive biopsy remains the diagnostic method of choice for NS. Prognosis correlates with steroid responsiveness, from sensitive (SSNS) to resistant (SRNS). Neutrophil gelatinase-associated lipocalin (NGAL) has been demonstrated to be a powerful risk marker of chronic kidney disease progression. We set out to determine if urine NGAL can distinguish between patients with SRNS, SSNS, and healthy controls.
METHODS
Urine and clinical data were collected from patients at Cincinnati Children's Hospital who were recently diagnosed with active nephrotic syndrome as well as healthy controls. Participants included SRNS (n = 15), SSNS (n = 14), and healthy controls (n = 10). Urinary NGAL was measured by ELISA and normalized to creatinine.
RESULTS
Median NGAL was significantly (p < 0.001) higher in SRNS (172.3 ng/ml, IQR 18.8-789) than both SSNS (6.3 ng/ml, IQR 4.9-9.9) and healthy controls (6.5 ng/ml, IQR 4.2-9.1). The area under the curve (AUC) for NGAL to distinguish SRNS from SSNS was 0.91 (p < 0.0001). NGAL levels demonstrated a significant negative correlation with glomerular filtration rate (r = -0.5, p < 0.001). Results did not change with NGAL corrected for urine creatinine and were independent of the degree of proteinuria.
CONCLUSIONS
NGAL levels differentiate SSNS from SRNS and correlate with disease severity in SRNS.
背景
特发性肾病综合征（NS）是儿童最常见的肾小球疾病。侵袭性活检仍然是 NS 的首选诊断方法。预后与类固醇反应性相关，从敏感（SSNS）到耐药（SRNS）。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）已被证明是慢性肾脏病进展的强有力风险标志物。我们旨在确定尿 NGAL 是否可以区分 SRNS、SSNS 和健康对照组患者。
方法
从辛辛那提儿童医院最近诊断为活动期肾病综合征的患者以及健康对照者中收集尿液和临床数据。参与者包括 SRNS（n=15）、SSNS（n=14）和健康对照组（n=10）。通过 ELISA 测量尿 NGAL 并按肌酐标准化。
结果
SRNS（172.3ng/ml，IQR 18.8-789）的中位数 NGAL 明显高于 SSNS（6.3ng/ml，IQR 4.9-9.9）和健康对照组（6.5ng/ml，IQR 4.2-9.1）（p<0.001）。NGAL 区分 SRNS 与 SSNS 的曲线下面积（AUC）为 0.91（p<0.0001）。NGAL 水平与肾小球滤过率呈显著负相关（r=-0.5，p<0.001）。结果在 NGAL 校正尿液肌酐后没有变化，并且与蛋白尿程度无关。
结论
NGAL 水平可区分 SSNS 与 SRNS，并与 SRNS 疾病严重程度相关。
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