原发性肾病综合征患儿检测结合珠蛋白和α1 抗胰蛋白酶对预测激素治疗反应的探讨

Value of determination of haptoglobin and α1-antitrypsin in predicting response to glucocorticoid therapy in children with primary nephrotic syndrome

摘要:

目的 探讨原发性肾病综合征(PNS)患儿血清及尿液中结合珠蛋白(HP)和α1 抗胰蛋白酶(AAT)的水平对预测激素治疗儿童PNS 疗效的价值。方法 将84 例PNS 患儿分为激素敏感型肾病综合征(SSNS)组(n=58)和激素耐药型肾病综合征(SRNS)组(n=26);随机抽取40 例健康儿童作为对照组。ELISA 法检测各组血、尿样本中HP 及AAT 水平。受试者工作特征曲线(ROC 曲线)评价HP 和AAT 对激素治疗PNS 疗效的预测效能。结果 SSNS 组与SRNS 组治疗前血清HP 浓度及尿AAT/Cr 比值均显著高于对照组(P<0.05);与SSNS 组比较,SRNS 组血清HP 浓度及尿AAT/Cr 比值在治疗前、治疗1 周及4 周时均显著升高(P<0.05)。当血清HP 浓度为37.935 mg/mL 时,其预测激素治疗儿童PNS 疗效的效能最高,敏感度为92.3%,特异度为86.2%;当尿AAT/Cr 比值为0.0696 时,其预测效能最高,敏感度为100%,特异度为79.3%;血清HP 联合尿AAT/Cr 比值作ROC 曲线分析,敏感度为92.3%,特异度为96.6%,具有更好的预测效能。结论 血清HP 或尿AAT/Cr 比值升高在PNS 患儿发病初期提示可能为激素耐药;如能两者联合检测对SRNS 预测效能更佳。

Abstract:

Objective To study the value of the determination of serum and urine haptoglobin (HP) and alpha 1-antitrypsin (AAT) in predicting the response to glucocorticoid therapy in children with primary nephrotic syndrome (PNS). Methods A total of 84 children with PNS were classified to steroid-sensitive nephrotic syndrome (SSNS) (n=58) and steroid-resistant nephrotic syndrome (SRNS) groups (n=26). Forty healthy children were randomly selected for the control group. HP and AAT levels in blood and urinary samples were determined using ELISA. The efficiency of HP and AAT in predicting the response to glucocorticoid treatment of PNS was evaluated by the receiver operating characteristic (ROC) curve. Results Compared with the control group, both the SSNS and SRNS groups had significantly higher serum HP concentrations and urine AAT/Cr ratio before treatment (P<0.05); compared with the SSNS group, the SRNS group had significantly higher serum HP concentrations and urine AAT/Cr ratio before treatment and after one week and four weeks of treatment (P<0.05). Serum HP had the highest efficiency in predicting the response to glucocorticoid treatment of PNS at the concentration of 37.935 mg/mL, with the sensitivity and specificity being 92.3% and 86.2% respectively. Urine AAT/Cr ratio had the highest prediction efficiency at 0.0696, with the sensitivity and specificity being 100% and 79.3% respectively. ROC curve analysis of serum HP combined with urine AAT/Cr ratio showed a better prediction efficiency, with the sensitivity and specificity being 92.3% and 96.6% respectively. Conclusions The increase in serum HP level or urine AAT/Cr ratio may indicate glucocorticoid resistance in the early stage of PNS. A combination of the two can achieve better efficiency in the prediction of SRNS.