原发性局灶节段性肾小球硬化患者血清可溶性尿激酶型纤溶酶原激活物受体检测及其诊断价值

摘要

目的：探讨血清可溶性尿激酶型纤溶酶原激活物受体（ suPAR ）水平检测对于诊断原发性局灶节段性肾小球硬化（ FSGS）的价值。方法选取常德市职业技术学院附属第一医院于2011年1月—2014年1月收治的临床病理资料完整的103例肾病综合征（ NS）患者，包括34例原发性膜性肾病（ MN）患者（ MN组）、30例原发性FSGS患者（ FSGS组）、26例原发性微小病变型肾病（ MCD）患者（ MCD组）和13例IgA肾病患者（ IgAN组）。检测4组患者血清中suPAR水平，并分析FSGS 组患者血清suPAR 水平与患者临床资料的关系；通过受试者工作特征曲线（ ROC曲线）分析suPAR诊断FSGS、 MN、 MCD的ROC曲线下面积（ AUC）、灵敏度和特异度。结果4组患者性别构成、血红蛋白、血清清蛋白、肌酸酐、24 h尿蛋白定量比较，差异无统计学意义（ P＞0.05）。4组患者年龄、肾小球滤过率（GFR）、 suPAR水平比较，差异有统计学意义（P＜0.05）。 FSGS组患者GFR低于MN组、 MCD组和IgAN组， MN组患者GFR低于MCD组和IgAN组（P＜0.05）； FSGS组患者血清suPAR水平高于MN组、 MCD组和IgAN组（P＜0.05）； MN组患者血清suPAR水平与MCD组和IgAN组患者比较，差异无统计学意义（P＞0.05）。 FSGS组患者血清suPAR水平与年龄和肌酸酐呈正相关（P＜0.05），与GFR呈负相关（P＜0.05）；血清suPAR水平与性别、血红蛋白、血清清蛋白、24 h尿蛋白定量无直线相关性（P＞0.05）。 suPAR诊断FSGS的AUC为0.723〔95％CI （0.702，0.769）〕，而suPAR诊断MCD和MN的AUC分别为0.455〔95％CI （0.382，0.486）〕和0.493〔95％CI （0.425，0.538）〕。 suPAR诊断FSGS的临界值为3542 ng／L，其灵敏度为79％，特异度为78％。结论血清suPAR 水平＞3542 ng／L对FSGS的诊断具有较大指导意义， suPAR有望成为辅助诊断FSGS的血清标志物。%Objective To investigate the value of the examination of soluble urokinase plasminogen activator receptor (suPAR) serum level in the diagnosis of primary focal segmental glomerular sclerosis (FSGS) .Methods The study enrolled 103 NS patients who were admitted into the First Affiliated Hospital of Changde Vocational Technical College from January 2011 to January 2014, including 34 patients with membranous nephropathy (MN group), 30 patients with primary FSGS (FSGS group) , 26 patients with minimal change disease ( MCD group ) and 13 IgA nephropathy ( IgAN group ) .The serum level of suPAR was tested, and the relation between serum level of suPAR and patients′clinical data were investigated.By ROC curves, the study analyzed the AUC , sensitivity and specificity of suPAR diagnosing FSGS , MN and MCD.Results The four groups were not significantly different in gender composition , hemoglobin , serum albumin , creatinine and 24 h urine protein ( P >0.05).The four groups were significantly different in age , GFR and suPAR ( P <0.05) .FSGS group was lower than MN group, MCD group and IgAN group in GFR , and MN group was lower than MCD group and IgAN group in GFR ( P<0.05);FSGS group was higher than MN group , MCD group and IgAN group in suPAR serum level ( P<0.05 ); MN group was not significantly different from MCD group and IgAN group in suPAR serum level ( P>0.05 ) .The serum suPAR level of FSGS group was positively correlated with age and creatinine (P<0.05) and was negatively correlated with GFR (P<0.05); suPAR serum level had no correlation with gender , hemoglobin, seryn albumin and 24 h urine protein (P>0.05) .The AUC of suPAR diagnosing FSGS was 0.723 〔95%CI (0.702, 0.769)〕, and AUC of suPAR diagnosing MCD and MN was 0.455 〔95%CI (0.382, 0.486)〕 and 0.493 〔95%CI (0.425, 0.538)〕 respectively.The critical value of suPAR diagnosing FSGS was 3 542 ng/L, and the sensitivity and specificity were 79%and 78%respectively.Conclusion The serum level of suPAR >3 542 ng/L has important diagnosis value , and suPAR has the potential to become a serum marker for the diagnosis of FSGS.