Şen Velat, Ece Aydın, Uluca Ünal, Söker Murat, Güneş Ali, Kaplan İbrahim, Tan İlhan, Yel Servet, Mete Nuriye, Sahin Cahit
Dicle University Medical School Department of Pediatrics , Diyarbakir , Turkey .
Ren Fail. 2015 May;37(4):607-13. doi: 10.3109/0886022X.2015.1007871. Epub 2015 Feb 6.
The aim of this study was to investigate novel urinary biomarkers including N-acetyl-β-D-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and liver-type fatty acid binding protein (L-FABP) in children with β-thalassemia major (β-TM).
Totally, 52 patients (29 boys, 23 girls) with β-TM and 29 healthy controls (3-17 years) were included. Various demographic characteristics and blood transfusions/year, disease duration, and chelation therapy were recorded. Serum urea, creatinine, electrolytes, and ferritin and urinary creatinine, protein, calcium, phosphorus, sodium, potassium, and uric acid in first morning urine samples were measured and estimated glomerular filtration rate (eGFR) was calculated. Routine serum and urinary biochemical variables, urinary NAG to Creatinine (U(NAG/Cr)), U(NGAL/Cr), U(KIM-1/Cr), and U(L-FABP/Cr) ratios were determined.
Patients had similar mean serum urea, creatinine and eGFR levels compared with controls (p > 0.05 for all). The mean urinary protein to creatinine (U(Protein/Cr)) ratio was significantly higher in patients compared to the healthy subjects (0.13 ± 0.09 mg/mg and 0.07 ± 0.04 mg/mg, respectively; p < 0.001). Significantly increased U(NAG/Cr) (0.48 ± 0.58 vs. 0.23 ± 0.16, p = 0.026) and U(NGAL/Cr) (22.1 ± 18.5 vs. 11.5 ± 6.17, p = 0.01) ratios were found in β-TM patients compared with healthy controls. However, no differences were found in serum and urinary electrolytes or U(KIM-1/Cr) and U(L-FABP/Cr) ratios between patients and controls (p > 0.05). Significant correlations were found between urinary biomarkers and urinary electrolytes (p < 0.05).
Our results suggest that urinary NAG and NGAL may be considered to be reliable markers to monitor renal injury in β-TM patients.
本研究旨在调查重型β地中海贫血（β-TM）患儿的新型尿液生物标志物，包括N-乙酰-β-D-氨基葡萄糖苷酶（NAG）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肾损伤分子-1（KIM-1）和肝型脂肪酸结合蛋白（L-FABP）。
共纳入52例β-TM患者（29例男孩，23例女孩）和29名健康对照者（3至17岁）。记录各种人口统计学特征、每年输血次数、疾病持续时间和螯合疗法。测量首次晨尿样本中的血清尿素、肌酐、电解质、铁蛋白以及尿肌酐、蛋白质、钙、磷、钠、钾和尿酸，并计算估算肾小球滤过率（eGFR）。测定常规血清和尿液生化变量、尿NAG与肌酐（U（NAG/Cr））、U（NGAL/Cr）、U（KIM-1/Cr）和U（L-FABP/Cr）比值。
与对照组相比，患者的血清尿素、肌酐和eGFR平均水平相似（均p>0.05）。患者的尿蛋白与肌酐（U（Protein/Cr））平均比值显著高于健康受试者（分别为0.13±0.09mg/mg和0.07±0.04mg/mg；p<0.001）。与健康对照相比，β-TM患者的U（NAG/Cr）（0.48±0.58对0.23±0.16，p=0.026）和U（NGAL/Cr）（22.1±18.5对11.5±6.17，p=0.01）比值显著升高。然而，患者与对照组之间的血清和尿液电解质或U（KIM-1/Cr）和U（L-FABP/Cr）比值无差异（p>0.05）。尿液生物标志物与尿液电解质之间存在显著相关性（p<0.05）。
我们的结果表明，尿NAG和NGAL可被视为监测β-TM患者肾损伤的可靠标志物。
