摘要：
目的 探讨尿液中单核细胞趋化蛋白-1(MCP-1)与IgA肾病肾小管间质病变的关系.方法 选取2012年3月至2015年8月临沂市沂水中心医院小儿内三科进行肾穿刺活检确诊的98例原发性IgA肾病患儿进行回顾性研究,根据活检病理肾小管间质的损害程度分为:无病变组11例、轻度组41例、中度组32例、重度组14例,检测各组患儿尿液中MCP-1及相关指标并进行分析.结果 中度组、重度组IgA肾病患儿的收缩压、舒张压水平均显著高于无病变组、轻度组患儿,差异均具有统计学意义(重度组与无病变组的收缩压、舒张压水平比较,t值分别为4.119、5.820;中度组与轻度组比较,t值分别为4.613、5.714;重度组与无病变组比较,t值分别为2.668、2.914;重度组与轻度组比较,t值分别为2.257、2.573,均P<0.05);无病变组、轻度组、中度组、重度组患儿的血肌酐、β2微球蛋白(β2-MG)、尿NAG、24h尿蛋白定量、尿MCP-1均呈逐渐升高的趋势,组间差异均具有统计学意义(F值分别为40.862、37.851、62.396、77.084、21.362,均P<0.05);肌酐清除率在无病变组、轻度组、中度组、重度组患儿中呈逐渐降低的趋势,组间差异具有统计学意义(F=43.396,P<0.05).肾小管间质的损害IgA肾病患儿的血肌酐、β2-MG、尿NAG、24h尿蛋白定量与尿MCP-1均呈显著的正相关关系(r值分别为0.671,0.598,0.664,0.692,均P<0.05),肌酐清除率与尿MCP-1呈显著的负相关关系(r=-0.720,P<0.05).结论 MCP-1能反应IgA肾病患儿肾小管间质病变的程度.%Objective To investigate the relationship between urinary monocyte chemotaxis protein -1 (MCP-1) and renal tubular interstitial lesion in IgA nephropathy .Methods A total of 98 patients with primary IgA nephropathy confirmed by renal biopsy were retrospectively studied from March 2012 to August 2015 in Yishui Central Hospital.They were divided into no lesion group (11 cases), mild group (41 cases), moderate group (32 cases) and severe group (14 cases) according to renal tubular interstitial damage degree in biopsy pathology . Urine MCP-1 and related indicators were detected and analyzed .Results The systolic blood pressure and diastolic blood pressure of moderate group and severe group were significantly higher than those of no lesion group and mild group , and the differences had statistical significance (comparing severe group to no lesion group, t value was 4.119 and 5.820;comparing moderate group to mild group, t value was 4.613 and 5.714;comparing severe group to no lesion group , t value was 2.668 and 2.914;comparing severe group to mild group , t value was 2.257 and 2.573, respectively, all P<0.05).Serum creatinine, β2 microglobulin (β2-MG), urinary NAG, 24h urinary protein, and urinary MCP-1 showed increasing trend in no lesion group , mild group, moderate group and severe group , and the differences between two groups had statistical significance (F value was 40.862, 37.851, 62.396, 77.084 and 21.362, respectively, all P<0.05). Creatinine clearance rate in no lesion group , mild group , moderate group and severe group was gradually reduced and the difference between two groups had statistical significance (F=43.396, P<0.05).Serum creatinine of renal tubular matter damage in children with IgA nephropathy,β2-MG and urinary NAG and 24h urinary protein were positively correlated with urinary MCP-1 (r value was 0.671, 0.598, 0.664 and 0.692, respectively, all P<0.05), and creatinine clearance rate was negatively correlated with urinary MCP-1 (r=-0.720, P<0.05).Conclusion MCP-1 can reflect the degree of renal tubular interstitial lesion in children with IgA nephropathy .
