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本研究旨在评估低分子尿蛋白诊断多发性骨髓瘤(MM)早期肾脏损害的临床诊断意义。回顾性分析2004年1月至2012年5月初诊的278例MM患者临床资料,按肾脏损害分为3组:肾小球损害组(血肌酐Scr≥2mg/dl)143例;肾小管损害组(Scr<2 mg/dl,尿视黄醇结合蛋白(retinol-binding protein,RBP)≥0.5 mg/L,尿N-乙酰-β-D-氨基葡萄糖胺酶(N-acetyl-β-D-aminoglucoamidase,NAG)≥17.8 U/g.cr)114例;无肾小球和肾小管损害的正常组21例。对3组间性别、年龄、分型、分期、血红蛋白(Hb)、血清白蛋白(Alb)、尿RBP及尿NAG等临床和实验室指标的差异进行比较,进一步分析所有患者尿RBP、尿NAG与血尿素氮(BUN)、血Scr、血胱抑素-C(Cys-C)、内生肌酐清除率(Ccr)、24 h尿蛋白、24 h尿轻链的相关性;并分析61例行肾脏活检患者的肾小管间质病变评分与低分子尿蛋白的相关性,使用ROC曲线比较尿RBP和尿NAG对MM早期肾脏损害的诊断效果。结果表明,肾小球损害组尿RBP显著高于肾小管损害组,而尿NAG显著低于肾小管损害组,两组尿RBP和尿NAG显著高于正常组;尿RBP与血Scr、血BUN、血Cys-C、24 h尿蛋白呈正相关,与Ccr呈负相关,而尿NAG与24 h尿蛋白、Ccr呈正相关,与血Cys-C呈负相关;肾小管间质病变与尿RBP显著相关,与尿NAG相关性较弱。结论:尿RBP与肾小管损害有明显的相关性,与尿NAG相比能更好地反映肾损伤的程度,并且特异性更高。
This study was designed to evaluate the clinical diagnostic significance of low molecular urine protein in the diagnosis of early renal damage in multiple myeloma (MM). The clinical data of 278 MM patients newly diagnosed from January 2004 to May 2012 were retrospectively analyzed. According to the renal damage, they were divided into 3 groups: 143 cases of glomerular damage group (Scr≥2mg / dl); renal tubular damage group (Scr <2 mg / dl, retinol-binding protein (RBP) ≥0.5 mg / L, urine N-acetyl-beta-D-glucosaminidase aminoglucoamidase, NAG) ≥17.8 U / g.Cr) 114 cases; no glomerular and tubular damage in the normal group of 21 cases. The differences of clinical and laboratory indexes such as sex, age, type, stage, Hb, Alb, urinary RBP and urinary NAG among the three groups were compared to further analyze urinary RBP, urinary NAG (CUN), serum creatinine (BUN), blood Scr, Cys-C, Ccr, 24 h urinary protein and 24 h urine light chain. Renal biopsy in patients with tubulointerstitial lesion score and low molecular proteinuria correlation, the use of ROC curve urinary RBP and urinary NAG on MM early diagnosis of renal damage. The results showed that the urinary RBP in glomerular damage group was significantly higher than that in renal tubular injury group, while the urinary NAG was significantly lower than that in renal tubular damage group. Urinary RBP and urinary NAG in both groups were significantly higher than those in normal group. Urinary RBP, blood Scr, , Cys-C, 24 h urinary protein and negatively correlated with Ccr, but urinary NAG was positively correlated with 24 h urinary protein and Ccr, but negatively correlated with Cys-C; tubulointerstitial lesions and urine RBP were significant Related, and urinary NAG weak correlation. CONCLUSION: Urinary RBP is significantly associated with renal tubular damage. Compared with urinary NAG, renal RBP can better reflect the degree of renal injury and its specificity is higher.