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尿液足细胞生物标志物在诊断免疫球蛋白A肾病中的价值▲
Value of urine podocyte biomarkers in the diagnosis of immunoglobulin A nephropathy

内科 202419卷01期 页码:1-6

作者机构: 广西医科大学第一附属医院肾内科,南宁市 530021

基金信息:国家自然科学基金(81960135);广西自然科学基金(2022GXNSFAA035458)

DOI:10.16121/j.cnki.cn45-1347/r.2024.01.01

  • 中文简介
  • 英文简介
  • 参考文献

目的 筛选在免疫球蛋白A肾病(IgAN)的诊断中具有临床价值的尿液足细胞生物标志物,并分析其与临床病理特征的相关性。方法 选取129例IgAN患者作为IgAN组,60例特发性膜性肾病(IMN)患者作为IMN组,63例健康志愿者作为健康组。检测并比较上述三组研究对象尿液中c‑Maf诱导蛋白(CMIP)、Ras同源基因家族成员A(RhoA)、丝切蛋白‑1(cofilin‑1)、可溶性尿激酶型纤溶酶原激活物受体(suPAR)、α‑klotho蛋白、肾病蛋白(nephrin)和足盂蛋白(PCX)的水平。应用受试者工作特征(ROC)曲线分析尿液足细胞生物标志物诊断IgAN的临床价值,应用Pearson或Spearman相关法分析尿液足细胞生物标志物与IgAN患者临床指标的相关性。结果 IgAN与IMN组间、IgAN与健康组间的cofilin‑1和suPAR水平均存在差异(均P<0.05)。suPAR诊断IgAN的ROC曲线下面积为0.730,suPAR联合cofilin‑1诊断IgAN的ROC曲线下面积为0.772(均P<0.05)。相关性分析结果提示,suPAR与收缩压、24 h尿蛋白、总胆固醇、高密度脂蛋白、牛津病理评分E呈正相关,与白蛋白呈负相关;cofilin‑1与收缩压和舒张压均呈正相关,与估算肾小球滤过率呈负相关。结论 IgAN患者的尿液足细胞生物标志物suPAR和cofilin‑1水平特异性升高,suPAR联合cofilin‑1在IgAN的无创诊断中有一定的价值。

Objective To screen out urine podocyte biomarkers with clinical value in the diagnosis of immunoglobulin A nephropathy (IgAN), and analyze their correlations with clinicopathological features. Methods A total of 129 IgAN patients were selected as the IgAN group, 60 idiopathic membranous nephropathy (IMN) patients as the IMN group, and 63 healthy volunteers as the healthy group. The urine levels of c‑Maf inducing protein(CMIP), Ras homolog gene family member A (RhoA), cofilin‑1, soluble urokinase‑type plasminogen activator receptor (suPAR), ɑ‑Klotho, nephrin, and podocalyxin (PCX) in the above three groups were detected and compared. The clinical value of urine podocyte biomarkers in the diagnosis of IgAN was analyzed using receiver operating characteristic (ROC) curve, and the correlations between urine podocyte biomarkers and clinical markers of IgAN patients were analyzed by the Pearson or Spearman correlation. Results There were differences in the levels of cofilin-1 and suPAR between IgAN and IMN groups and between IgAN and healthy groups(all P<0.05). The area under the ROC curve of suPAR in the diagnosis of IgAN was 0.730, and the area under the ROC curve of the combination of suPAR and cofilin-1 in the diagnosis of IgAN was 0.772 (all P<0.05). The results of correlation analysis showed that the suPAR level was positively correlated with systolic blood pressure, 24-hour urine protein, total cholesterol, high-density lipoprotein levels, and Oxford classification system score of endocapillary hypercellularity, and negatively correlated with the albumin level; the cofilin-1 level was positively correlated with both systolic and diastolic blood pressure, and negatively correlated with the estimated glomerular filtration rate. Conclusion The urine levels of podocyte biomarkers, suPAR and cofilin-1, are abnormally elevated in patients with IgAN, and the combination of suPAR and cofilin-1 levels has certain value in the non-invasive diagnosis of IgAN.


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