慢性肾脏病患者血清人附睾分泌蛋白4与肾小球滤过率的相关性研究

摘要

目的：比较不同分期的慢性肾脏病（CKD）患者血清人附睾分泌蛋白4（HE4）、血清半胱氨酸蛋白酶抑制剂 C（Cystatin C）和血清肌酐（Scr）的符合率，研究 CKD 患者血清 HE4与估算的肾小球滤过率（eGFR）的相关性。方法分别采用电化学发光法、颗粒增强免疫透射比浊法、肌氨酸氧化酶法检测136例 CKD 患者和67名健康对照组的血清 HE4、血清 Cystatin C 和血清 Scr 水平，比较血清 HE4与 eGFR 、血清 Cystatin C 和血清Scr 水平的相关性，分析血清 HE4、血清 Cystatin C 和血清 Scr 水平在 CKD 不同分期患者间的水平差异和不同分期内血清 HE4、血清 Cystatin C 和血清 Scr 的异常率。结果血清 HE4浓度与 eGFR 呈负相关（ r ＝－0•7033， P ＜0•05）；血清 HE4浓度与血清 Cystatin C 浓度呈正相关（r＝0•8719，P＜0•05），血清 HE4浓度与血清 Scr 浓度呈正相关（ r ＝0•8489，P ＜0•05）。 CKD 患者血清 HE4、血清 Cystatin C 和血清 Scr 水平随着 CKD 病情的加重显著升高，血清 HE4、血清 Cystatin C 和血清 Scr 平均水平在各期间的差异均有统计学意义（ P ＜0•05）。在CKD 5期组和 CKD 4期组，HE4、Cystatin C 和 Scr 的异常率均为100％。在 CKD 3期组，HE4、Cystatin C 和 Scr的异常率分别为95•5％，95•5％和86•4％，3个指标异常率的差异无统计学意义（ P ＞0．05）；在 CKD 2期组， HE4的异常率为81．5％，Cystatin C 的异常率为88•9％，Scr 的异常率仅为44．4％，3个指标异常率的差异有统计学意义（ P ＜0．05）；CKD1期组，HE4和 Cystatin C 的异常率为36．7％和43•3％，2个指标异常率的差异无统计学意义（ P ＞0．05），而 Scr 的异常率为0。结论血清 HE4浓度与 eGFR 呈负相关，其水平在非卵巢癌肾脏病患者中随着病情加重显著升高，异常检出率与 CystatinC 相当，优于 Scr 。%Objective To compare the coincidence rate of Chronic Kidney Disease(CKD)patients′ human ep‐ididymis secretory protein 4(HE4) ,Cystatin C and serum creatinine(Scr) ,and to make the association study be‐tween CKD patients′ HE4 and eGFR .Methods Tests are conducted with the method of electrochemilumines‐cence ,the method of scattering particles enhancing the immune turbidimetry and the method of sarcosine oxidase to measure values of serum HE4 ,Cystatin C ,and Scr among 136 cases of CKD patients and 67 cases of control . We analyze the association of serum HE4 ,Cystatin C ,and Scr ,and the horizontal differentiation of serum HE4 , Cystatin C ,and Scr in different stages of CKD patients ,and abnormal rate of serum HE4 ,Cystatin C ,and Scr in different stages• Results It demonstrates the negative correlation between HE4 concentration and eGFR( r =- 0•703 3 ,P < 0•05) ;positive correlation between HE4 concentration and serum Cystatin C( r = 0•871 9 ,P <0•05) ,positive correlation between HE4 concentration and Scr (r = 0•848 9 ,P < 0•05) .The values of serum HE4 ,Cystatin C ,and Scr increase significantly with CKD condition′s aggravation .The difference was statistically significant for serum HE4 ,Cystatin C ,and Scr in each stage ( P < 0•05) .The abnormal rate of serum HE4 , Cystatin C ,and Scr is up to 100% in group of CKD stage 5 and CKD stage 4 .The abnormal rates of serum HE4 , Cystatin C ,and Scr in group of CKD stage 3 are 95•5% ,95•5% 和 86•4% ,respectively ,which has no statistical significance among them ( P > 0 .05) .The abnormal rate of HE4 ,Cystatin C and Scr were 81•5% ,88•9% and 44•4% respectively in group of CKD stage 2 ,which had statistical significance among them ( P < 0 .05) .The ab‐normal rates of HE4 and Cystatin C are 36 .7% and 43•3% ,which had no statistical significance among them ( P> 0 .05) ,but the abnormal rate of Scr is 0 .Conclusion It demonstrates the negative correlation between serum HE4 concentration and eGFR .Serum HE4 value increases according to condition′s aggravation among kidney dis‐ease patients with non‐ovarian cancer ,its abnormal detection is the same as Cystatin C and better than Scr .