Zhong Yun, Yuan Zhen-gang, Fu Wei-jun, Zhou Fan, Zhang Chun-yang, Zhang Wen-hao, Hou Jian
Department of Hematology, Second Military Medical Hospital, Shanghai, China.
Zhonghua Xue Ye Xue Za Zhi. 2012 Oct;33(10):819-22.
To investigate the value of serum cystatin C (Cys-C), urinary Cys-C, urinary retinol binding protein (RBP) and urinary neutrophil gelatinase-associated lipocalin (NGAL) in the early assessment of multiple myeloma (MM) and their characteristic changes in different pathological types of renal impairment.
According to glomerular filtration rate (eGFR), the patients were divided into two groups, of which marked group A with normal renal function, the other marked group B with abnormal renal function. Sixty healthy subjects were chosen as control. Detection of the serum Cys-C, urinary RBP, urinary Cys-C, urinary NGAL, serum creatinine (Scr), urinary microalbumin (MAU) and urinary α1-microglobulin (α1-MG) were performed. Renal biopsy was carried out for patients who had abnormal serum Cys-C, urinary Cys-C, urinary RBP, urinary NGAL and were willing to accept further test.
Compared with healthy controls, the serum Cys-C, urinary RBP, urinary Cys-C, urinary NGAL of group A were significantly higher than that of healthy controls. Six group A patients received renal biopsy, and varying degrees of renal damage were discovered. The serum Cys-C, urinary RBP, urinary Cys-C and urinary NGAL positive rate were 66.7%, 66.7%, 66.7% and 83.3%, respectively. Of twenty-four cases received biopsy after abnormal examination results were shown, six turned out to be amyloidosis, twelve cast nephropathy (CN) and 6 monoclonal immunoglobulin deposition disease (MIDD). Compared with MIDD and amyloidosis, the urinary Cys-C and NGAL of the CN group are significantly higher (P < 0.05). Compared with CN and amyloidosis, urinary RBP of MIDD is significantly higher (P = 0.043). Compared with MIDD and CN, the MAU of amyloidosis is significantly higher (P = 0.006).
Compared with the conventional indicators, serum Cys-C, urinary Cys-C, RBP and NGAL are more sensitive in early assessment of MM patients with renal damage. The MAU is higher in amyloid, the urinary Cys-C and urinary NGAL are significantly elevated in CN, the urinary RBP is significantly elevated in MIDD.
探讨血清胱抑素C（Cys-C）、尿Cys-C、尿视黄醇结合蛋白（RBP）及尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在多发性骨髓瘤（MM）早期评估中的价值及其在不同病理类型肾功能损害中的特征性变化。
根据肾小球滤过率（eGFR）将患者分为两组，其中肾功能正常者为A组，肾功能异常者为B组。选取60例健康受试者作为对照。检测血清Cys-C、尿RBP、尿Cys-C、尿NGAL、血清肌酐（Scr）、尿微量白蛋白（MAU）及尿α1-微球蛋白（α1-MG）。对血清Cys-C、尿Cys-C、尿RBP、尿NGAL异常且愿意接受进一步检查的患者进行肾活检。
与健康对照组相比，A组血清Cys-C、尿RBP、尿Cys-C、尿NGAL均显著高于健康对照组。A组6例患者接受肾活检，发现不同程度的肾损害。血清Cys-C、尿RBP、尿Cys-C及尿NGAL阳性率分别为66.7%、66.7%、66.7%和83.3%。检查结果异常后接受活检的24例患者中，6例为淀粉样变性，12例为管型肾病（CN），6例为单克隆免疫球蛋白沉积病（MIDD）。与MIDD和淀粉样变性相比，CN组尿Cys-C和NGAL显著升高（P<0.05）。与CN和淀粉样变性相比，MIDD的尿RBP显著升高（P=0.043）。与MIDD和CN相比，淀粉样变性的MAU显著升高（P=0.006）。
与传统指标相比，血清Cys-C、尿Cys-C、RBP和NGAL在MM患者肾损害早期评估中更敏感。淀粉样变性中MAU较高，CN中尿Cys-C和尿NGAL显著升高，MIDD中尿RBP显著升高。
