Liu Shi-Jing, Zhai Yong-Ping, Yu Ya-Ping, Liu Hai-Ning, Li Feng, Song Ping, Zhou Xiao-Gang, An Zhi-Ming, Shao Jing-Jing, Yang Xiao-Yan
Department of Hematology, Nanjing General Hospital of Nanjing Military Area, Nanjing, Jiangsu Province, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2013 Apr;21(2):410-4. doi: 10.7534/j.issn.1009-2137.2013.02.031.
This study was purposed to evaluate the clinical significance of low molecular weight urinary proteins for diagnosis of early renal damage in patients with multiple myeloma (MM). Medical records of 278 patients with MM in Nanjing School of Clinical Medicine from January 2004 to May 2012 were analyzed retrospectively. These patients were divided into 3 groups: glomerular damage group (n = 143), tubular damage group (n = 114) and normal group (n = 21). The clinical and laboratorial data were compared among them. The correlations of urinary retinol-binding protein (RBP) or urinary N-acetyl-β-D-amino-glucosaminidase (NAG) with blood urea nitrogen (BUN), Scr, blood cystatin-C (Cys-C), clearance of creatinine (Ccr), 24 h protein uria and 24 h urine light chains were further analyzed, and the correlation of renal tubulointerstitial lesion scores with low molecular weight urinary proteins in 61 patients were also analyzed. The area under curve (ROC curve) was used to evaluate and compare the discrimination of urinary RBP and urinary NAG. The results showed that glomerular damage group had higher urinary RBP than tubular damage group. However, glomerular damage group had lower urinary NAG than tubular damage group. The two groups had higher urinary RBP and urinary NAG than that in normal group. Urinary RBP related positively to the level of Scr, BUN, Cys-C, 24 h proteinurias and related negatively to the level of Ccr. Urinary NAG related positively to the level of 24 h proteinurias, Ccr and related negatively to the level of Cys-C. Renal tubulointerstitial lesions were significantly correlated with urinary RBP, but weakly correlated with urinary NAG. It is concluded that urinary RBP significantly correlates with renal tubular damage. Compared with urinary NAG, urinary RBP can better assess the extent of renal damage, and has higher specificity.
本研究旨在评估低分子量尿蛋白对多发性骨髓瘤（MM）患者早期肾损伤诊断的临床意义。回顾性分析了南京临床医学院2004年1月至2012年5月期间278例MM患者的病历。这些患者被分为3组：肾小球损伤组（n = 143）、肾小管损伤组（n = 114）和正常组（n = 21）。比较了他们的临床和实验室数据。进一步分析了尿视黄醇结合蛋白（RBP）或尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）与血尿素氮（BUN）、Scr、血胱抑素C（Cys-C）、肌酐清除率（Ccr）、24小时蛋白尿和24小时尿轻链的相关性，并分析了61例患者肾小管间质病变评分与低分子量尿蛋白的相关性。采用曲线下面积（ROC曲线）评估和比较尿RBP和尿NAG的鉴别能力。结果显示，肾小球损伤组的尿RBP高于肾小管损伤组。然而，肾小球损伤组的尿NAG低于肾小管损伤组。两组的尿RBP和尿NAG均高于正常组。尿RBP与Scr、BUN、Cys-C水平及24小时蛋白尿呈正相关，与Ccr水平呈负相关。尿NAG与24小时蛋白尿、Ccr水平呈正相关，与Cys-C水平呈负相关。肾小管间质病变与尿RBP显著相关，但与尿NAG相关性较弱。结论是，尿RBP与肾小管损伤显著相关。与尿NAG相比，尿RBP能更好地评估肾损伤程度，且具有更高特异性。
