Zheng S, Zhao Z H, Liu Z J, Wang D H, Liu D W, Liu Z S
Department of Nephrology, Zhumadian Central Hospital, Zhumadian 463000, China.
Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology, Zhengzhou University, Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2020 Apr 28;100(16):1230-1234. doi: 10.3760/cma.j.cn112137-20191205-02656.
To explore the changes and clinical value of urinary monocyte chemotactic protein 1 (MCP-1), epidermal growth factor (EGF) and their ratio in patients with idiopathic membranous nephropathy (IMN). A total of 67 IMN patients were enrolled according to kidney biopsy in the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2018. The patients included 28 males and 39 females, with an average age of (47.6±14.2) years. Eighteen age-and sex-matched healthy controls were also enrolled. Clinical and pathological data, blood and urine samples of all subjects were collected. Urinary MCP-1 and EGF level were detected by enzyme-linked immunosorbent assay (ELISA). And then the levels of urinary MCP-1, EGF and the ratio of EGF/MCP-1 and their correlations with clinicopathology were analyzed. There was no statistical difference of the urine EGF levels between the two groups [8.3(6.0,12.6) vs 8.4(6.5,10.2) ng/mg Cr, 0.575]. The urine MCP-1 levels of IMN patients were 0.37 (0.21, 0.69) ng/mg Cr, which was statistical significantly higher than those of the control group [0.09 (0.02, 0.19) ng/mg Cr] (0.001), while the EGF/MCP-1 ratio was lower than that of the control group [22.2(15.1,36.6) vs 87.6(71.2,132.7), 0.001]. Urine MCP-1 was negatively correlated with eGFR (-0.303, 0.012), but positively correlated with the urinary ratio of albumin to creatinin (0.368, 0.002). EGF was positively correlated with eGFR (0.722, 0.001), but negatively correlated with the severity of interstitial fibrosis and renal tubular atrophy (IFTA) (-0.312, 0.011). EGF/MCP-1 ratio was positively correlated with eGFR (0.693, 0.001), but negatively correlated with the severity of the urinary ratio of albumin to creatinin and IFTA (-0.261, 0.028 and -0.684, 0.001, respectively). Further multivariate logistic regression analysis showed that EGF/MCP-1 was a protective factor for moderate-to-severe IFTA (0.891, 95: 0.844-0.949, 0.008). Patients with IMN have elevated urine MCP-1 level and decreased EGF/MCP-1 ratio, which correlate with clinical indicators. In particular, EGF/MCP-1 ratio is independently related to moderate-severe IFTA, and may be a potential clinical biomarker for diagnosis of IMN.
探讨特发性膜性肾病（IMN）患者尿单核细胞趋化蛋白1（MCP-1）、表皮生长因子（EGF）及其比值的变化及临床价值。2017年1月至2018年12月，郑州大学第一附属医院肾内科根据肾活检纳入67例IMN患者。患者包括28例男性和39例女性，平均年龄（47.6±14.2）岁。还纳入了18例年龄和性别匹配的健康对照。收集所有受试者的临床和病理资料、血液和尿液样本。采用酶联免疫吸附测定（ELISA）检测尿MCP-1和EGF水平。然后分析尿MCP-1、EGF水平、EGF/MCP-1比值及其与临床病理的相关性。两组尿EGF水平无统计学差异[8.3（6.0，12.6）对8.4（6.5，10.2）ng/mg Cr，0.575]。IMN患者尿MCP-1水平为0.37（0.21，0.69）ng/mg Cr，显著高于对照组[0.09（0.02，0.19）ng/mg Cr]（0.001），而EGF/MCP-1比值低于对照组[22.2（15.1，36.6）对87.6（71.2，132.7），0.001]。尿MCP-1与估算肾小球滤过率（eGFR）呈负相关（-0.303，0.012），但与尿白蛋白与肌酐比值呈正相关（0.368，0.002）。EGF与eGFR呈正相关（0.722，0.001），但与间质纤维化和肾小管萎缩（IFTA）的严重程度呈负相关（-0.312，0.011）。EGF/MCP-1比值与eGFR呈正相关（0.693，0.001），但与尿白蛋白与肌酐比值及IFTA的严重程度呈负相关（分别为-0.261，0.028和-0.684，0.001）。进一步的多因素逻辑回归分析显示，EGF/MCP-1是中重度IFTA的保护因素（0.891，95%置信区间：0.844-0.949，0.008）。IMN患者尿MCP-1水平升高，EGF/MCP-1比值降低，与临床指标相关。特别是，EGF/MCP-1比值与中重度IFTA独立相关，可能是IMN诊断的潜在临床生物标志物。
