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目的:探讨成人微小病变(MCD)患者尿液CD80在MCD发生与发展中的作用及其对MCD与局灶节段性肾小球硬化(FSGS)鉴别诊断的意义。方法:MCD患者35例(肾病组初治9例和复发10例,完全缓解组16例),其中9例初治患者经随访后完全缓解,行自身配对研究;同期原发FSGS肾病综合征患者18例。记录所有患者相关资料。ELISA法测尿CD80浓度(ng/ml)及血清白细胞介素13(IL-13)(pg/ml)水平,其中尿CD80值用尿肌酐值(g/ml)校正。结果:(1)尿CD80/肌酐水平:MCD肾病组明显高于MCD完全缓解组或FSGS肾病组[247.0ng/g(196.0~378.0 ng/g)vs 42.0 ng/g(24.0~76.3 ng/g)、73.0 ng/g(35.3~172.0 ng/g),P<0.05],MCD完全缓解组与FSGS肾病组无统计学差异;MCD初治组与复发组无统计学差异。(2)血IL-13水平在MCD肾病组、MCD完全缓解组及FSGS肾病组中无统计学差异。(3)自身配对研究示:MCD完全缓解后较治疗前尿CD80/肌酐水平显著下降[41.0 ng/g(17.0~61.5 ng/g)vs 323.0 ng/g(225.5~587.5 ng/g),Z=2.666,P=0.008],而血IL-13水平无统计学差异(Z=0.847,P=0.397)。(4)MCD肾病组尿CD80/肌酐与24h尿蛋白定量及血IL-13水平均无相关性(分别r=-0.219,P=0.369;r=0.303,P=0.205)。(5)尿CD80鉴别诊断MCD和FSGS的ROC曲线下面积(AUC)为0.883(截点为194.5 ng/ml,其敏感度为78.9%,特异性为88.9%)。结论:CD80可能参与了MCD发生及发展,且可作为成人肾病综合征患者MCD与FSGS鉴别诊断的新指标。
Objective: To investigate the role of urine CD80 in the development and progression of MCD in patients with adult minimal change (MCD) and its significance in differential diagnosis between MCD and focal segmental glomerulosclerosis (FSGS). Methods: Thirty-five MCD patients (9 newly diagnosed nephropathy patients and 10 relapsed patients and 16 complete remission patients), and 9 newly diagnosed patients were completely relieved after follow-up. The patients with primary FSGS nephrotic syndrome 18 cases. Record all patient related information. Urine CD80 concentration (ng / ml) and serum interleukin 13 (IL-13) (pg / ml) were measured by ELISA. Urine CD80 was corrected with urinary creatinine (g / ml) Results: (1) Urinary CD80 / creatinine levels in MCD nephropathy group were significantly higher than those in MCD complete remission group or FSGS nephropathy group [247.0ng / g (196.0- 378.0 ng / g) vs 42.0 ng / g ), 73.0 ng / g (35.3 ~ 172.0 ng / g), P <0.05]. There was no significant difference between MCD complete remission group and FSGS nephropathy group. There was no significant difference between MCD initial group and recurrence group. (2) There was no significant difference in serum IL-13 levels between MCD nephropathy group, MCD complete remission group and FSGS nephropathy group. (3) The self-matched study showed that the serum CD80 / creatinine levels were significantly decreased after MCD was completely relieved (41.0 ng / g vs 323.0 ng / g, 225.5-587.5 ng / g, respectively) = 2.666, P = 0.008], while there was no significant difference in blood IL-13 levels (Z = 0.847, P = 0.397). (4) There was no correlation between urinary CD80 / creatinine and urinary protein excretion and blood IL-13 level in MCD nephropathy group (r = -0.219, P = 0.369; r = 0.303, P = 0.205 respectively). (5) Urine CD80 differential diagnosis The area under the ROC curve (AUC) for MCD and FSGS was 0.883 (cutoff of 194.5 ng / ml, with a sensitivity of 78.9% and a specificity of 88.9%). Conclusion: CD80 may be involved in the occurrence and development of MCD and may serve as a new marker for the differential diagnosis of MCD and FSGS in patients with adult nephrotic syndrome.