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“钙卫蛋白”和“内皮抑素”能否作为“肾脏病医生的肌钙蛋白”?

Could "calprotectin" and "endocan" serve as "Troponin of Nephrologists"?

作者信息

Azimi Arsalan

机构信息

Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

出版信息

Med Hypotheses. 2017 Feb;99:29-34. doi: 10.1016/j.mehy.2016.12.008. Epub 2016 Dec 19.

Abstract

AKI, a serious, common and occasionally under-recognized condition, which is a significant contributor to the growing incidence of CKD and end-stage renal disease (ESRD). To date, the diagnosis of AKI is made by serial measurement of Cr and BUN which are late and imprecise markers of kidney injury. "Calprotectin" and "endocan" are two biomarkers that could reflect renal tubular injury and glomerular/endothelial-vascular damage, respectively. Measurement of urinary calprotectin could help the physicians to diagnose tubular degradation and differentiate prerenal AKI from intrinsic AKI. Serum level of endocan could signify endothelial damage. Herein it is hypothesized that calprotectin and endocan may help the clinicians to diagnose intrinsic AKI, earlier than rise of serum creatinine, differentiate AKI from acute presentation of CKD and also discriminate tubular injury from glomerular/vascular-endothelial injury, assess the prognosis and extent of renal damage and plan for appropriate therapy which may render these biomarkers as potentially applicable equivalents of Troponin in the field of nephrology.

摘要

急性肾损伤(AKI)是一种严重、常见且有时未被充分认识的病症,是慢性肾脏病(CKD)和终末期肾病(ESRD)发病率不断上升的重要因素。迄今为止,AKI的诊断是通过连续测量肌酐(Cr)和尿素氮(BUN)来进行的,而这两者都是肾脏损伤的晚期且不准确的标志物。“钙卫蛋白”和“内皮糖蛋白”是两种生物标志物,分别可反映肾小管损伤和肾小球/内皮血管损伤。检测尿钙卫蛋白有助于医生诊断肾小管退化,并区分肾前性AKI和内在性AKI。内皮糖蛋白的血清水平可表明内皮损伤。本文假设,钙卫蛋白和内皮糖蛋白可能有助于临床医生比血清肌酐升高更早地诊断内在性AKI,将AKI与CKD的急性表现区分开来,还能区分肾小管损伤与肾小球/血管内皮损伤,评估肾损伤的预后和程度,并制定适当的治疗方案,这可能使这些生物标志物成为肾脏病领域中肌钙蛋白的潜在适用等效物。

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