中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (02): 82-87.doi: 10.3969/j.issn.1671-4091.2018.02.003

• 临床研究 • 上一篇    下一篇

尿Tamm-Horsfall 蛋白水平联合尿液补体H因子水平和IgA 肾病Haas 分级及预后相关

王雅琴1,刘茂静1,周晶晶1,王素霞2,陈育青1   

  1. 北京大学第一医院1肾内科，北京大学肾脏疾病研究所，卫生部肾脏疾病重点实验室，慢性肾脏病防治教育部重点实验室； 2电镜室
  • 收稿日期:2017-10-11 修回日期:2017-12-21 出版日期:2018-02-12 发布日期:2018-02-12
  • 通讯作者: 陈育青 cyq@bjmu.edu.cn E-mail:cyq@bjmu.edu.cn
  • 基金资助:

    国家自然科学基金资助项目(81570664)

Urinary Tamm-Horsfall protein level combined with urinary complement factor H level can predict IgA nephropathy Haas classification and renal outcome

  • Received:2017-10-11 Revised:2017-12-21 Online:2018-02-12 Published:2018-02-12

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摘要： 目的探讨肾活检时尿Tamm-Horsfall 蛋白水平联合尿补体H 因子水平与IgA 肾病患者的组织学分型及预后的相关性。方法选择在在北京大学第一医院接受肾活检和规律治疗及随访的IgA肾病患者351 例。收集其基线临床病理资料，病理表现按照Haas 分级进行打分。检测基线时尿Tamm-Horsfall 蛋白水平和尿补体H 因子水平，分析该两种因子与临床，病理及预后的相关性。预后指标用肾脏终点事件表示，肾脏复合终点事件包括：①终末期肾脏病[估算肾小球滤过率(estimated glomerular filtration rate,eGFR)＜15mL/min?1.73 m2]；②eGFR 比初始下降≥50%；③血肌酐水平加倍。结果 尿Tamm-Horsfall 蛋白水平越低，同时补体H 因子水平越高，IgA 肾病患者的24h 尿蛋白定量越多 ( χ2 =37.899, P＜0.001)，血白蛋白水平 ( χ2 = 37.487, P＜0.001)、eGFR 水平(F=16.333, P＜0.001)水平越低；同时，按照Haas 分型的组织学损伤更严重(χ2=52.304, P＜0.001)，复合终点事件发生率更高(χ2=35.678, P＜0.001)。Kaplan-Meier 生存分析曲线显示，尿中补体H 因子越高，同时Tamm-Horsfall 蛋白越低，患者的预后越差(Log Rank χ2=31.938, P＜0.001)。结论尿Tamm-Horsfall 蛋白和尿补体H 因子水平可联合预测是IgA 肾病患者的预后。尿液中补体H 因子越高，尿Tamm-Horsfall 蛋白水平越低，IgA 肾病患者的组织学Haas分型越严重，预后越差。

关键词: Tamm-Horsfall蛋白, 补体H因子, IgA肾病, Haas分型

Abstract: Objectives To investigate whether urinary Tamm- Horsfall protein (uTHP) level combined with urinary complement factor H (uCFH) level can correlate with IgA nephropathy histology Haas classification and renal outcome. Methods A total of 351 IgA nephropathy patients followed up from Sep. 2003 to Sep. 2014 were enrolled in this study. Histological changes were evaluated by using the Haas classification of IgA nephropathy. Enzyme linked immunosorbent assay (ELISA) was used to measure uTHP and uCFH levels at the renal biopsy day. Composite endpoint of renal outcome was defined as ①end-stage renal disease (ESRD), ②≥ 50% decline of estimated glomerular filtration rate (eGFR), and ③doubling of plasma creatinine level. Results In this cohort, patients with lower uTHP level and higher uCFH level had more proteinuria (χ2=37.899, P＜0.001), lower blood albumin (χ2=37.487, P＜0.001), lower eGFR(F=16.333, P＜0.001), severer histological lesion (χ2=52.304, P＜0.001) and worse renal outcome (χ2=35.678, P＜0.001). Kaplan-Meier curve analysis indicated that lower uTHP level with higher uCFH level predicted the worse renal outcome during follow-up (Log Rank test, χ2=31.938, P＜0.001). Conclusions uTHP level combined with uCFH level can predict renal outcome in IgA nephropathy patients. Patients with lower uTHP and higher uCFH will have severer morphological lesions (Haas classification) and worse renal outcome.

Key words: Tamm-Horsdall Protein, Complement factor H, IgA nephropathy, Haas classification.