Grubb Anders, Lindström Veronica, Jonsson Magnus, Bäck Sten-Erik, Åhlund Tomas, Rippe Bengt, Christensson Anders
Department of Clinical Chemistry, Skåne University Hospital , Lund.
Scand J Clin Lab Invest. 2015 Jul;75(4):333-40. doi: 10.3109/00365513.2015.1025427.
The plasma levels of cystatin C, β2-microglobulin, beta-trace protein, retinol binding protein (RBP) and creatinine were determined in plasma samples from 111 randomly selected patients with eGFRcystatin C ≤ 60% of eGFRcreatinine and from 55 control patients with 0.9eGFRcreatinine ≤ eGFRcystatin C ≤ 1.1eGFRcreatinine (eGFRcystatin C ≈ eGFRcreatinine). The concentration ratios of cystatin C/creatinine, β2-microglobulin/creatinine, beta-trace protein/creatinine and RBP/creatinine were significantly higher in patients with eGFRcystatin C ≤ 60% of eGFRcreatinine than in patients with eGFRcystatin C ≈ eGFRcreatinine. When the patients were divided into three groups with different estimated GFR intervals (≤ 40, 40-60 and ≥ 60 mL/min/1.73m(2)) the concentration ratios of cystatin C/creatinine, β2-microglobulin/creatinine, and beta-trace protein/creatinine were significantly higher in patients with eGFRcystatin C ≤ 60% of eGFRcreatinine than in patients with eGFRcystatin C ≈ eGFRcreatinine for all GFR intervals. Similar results were obtained when the population without pregnant women was studied as well as the subpopulations of men or of non-pregnant women. Populations of pre-eclamptic women and pregnant women in the third trimester display similar results. Since the production of these four proteins with sizes similar to that of cystatin C is not co-regulated, the most likely explanation for the simultaneous increase of their creatinine-ratios in patients with eGFRcystatin C ≤ 60% of eGFRcreatinine is that their elimination by glomerular filtration is decreased. We suggest that this is due to a reduction in pore diameter of the glomerular membrane and propose the designation 'Shrunken pore syndrome' for this pathophysiological state.
在111例随机选取的估算肾小球滤过率（eGFR）胱抑素C≤eGFR肌酐60%的患者以及55例0.9eGFR肌酐≤eGFR胱抑素C≤1.1eGFR肌酐（eGFR胱抑素C≈eGFR肌酐）的对照患者的血浆样本中，测定了胱抑素C、β2-微球蛋白、β-微量蛋白、视黄醇结合蛋白（RBP）和肌酐的血浆水平。eGFR胱抑素C≤eGFR肌酐60%的患者中，胱抑素C/肌酐、β2-微球蛋白/肌酐、β-微量蛋白/肌酐和RBP/肌酐的浓度比显著高于eGFR胱抑素C≈eGFR肌酐的患者。当将患者分为三个不同估算肾小球滤过率区间（≤40、40 - 60和≥60 mL/min/1.73m²）的组时，在所有肾小球滤过率区间内，eGFR胱抑素C≤eGFR肌酐60%的患者中，胱抑素C/肌酐、β2-微球蛋白/肌酐和β-微量蛋白/肌酐的浓度比均显著高于eGFR胱抑素C≈eGFR肌酐的患者。在不包括孕妇的人群以及男性或非孕妇亚组中研究时，也获得了类似结果。子痫前期妇女和孕晚期孕妇群体显示出类似结果。由于这四种大小与胱抑素C相似的蛋白质的产生并非共同调节，eGFR胱抑素C≤eGFR肌酐60%的患者中其肌酐比值同时升高的最可能解释是它们通过肾小球滤过的清除减少。我们认为这是由于肾小球膜孔径减小所致，并为此病理生理状态提出“收缩孔综合征”这一名称。
