Zhao Yijun,Chen Junyi,Tang Daxing.Clinical significance of urine protein measurement in children with severe hydronephrosis after percutaneous nephrostomy and correlation with renal function[J].Journal of Clinical Pediatric Surgery,2021,20(04):319-324.[doi:10.12260/lcxewkzz.2021.04.004]
儿童重度肾积水肾造瘘术后尿蛋白水平与肾功能的关系
- Title:
- Clinical significance of urine protein measurement in children with severe hydronephrosis after percutaneous nephrostomy and correlation with renal function
- 分类号:
- R692.2;R696+.2
- 摘要:
- 目的 探讨儿童重度肾积水肾造瘘术后肾盂尿液中分子量大小不等的尿微量白蛋白（mAlb）、α1微球蛋白（α1-MG）、β2微球蛋白（β2-MG）、转铁蛋白（Trf）、免疫球蛋白G （IgG）的改变及其临床意义，分析其与肾功能的关系。方法 收集2017年3月至2020年10月由浙江大学医学院附属儿童医院泌尿外科收治的17例单侧重度肾积水行肾造瘘术患者的临床资料。研究对象在同一时间段内接受肾核素扫描评估分肾功能（differential renal function，DRF）及经皮肾穿刺造瘘术，留取肾盂尿液行尿蛋白检测。以DRF<22.1%和DRF≥22.1%将造瘘3个月后的17例患者分为低分肾功能组（n=11）和高分肾功能组（n=6），分析两组患侧肾盂尿液中尿mAlb/Cr、α1-MG/Cr、β2-MG/Cr、Trf/Cr、IgG/Cr、（mAlb+Trf+IgG）/Cr、（α1-MG+β2-MG）/Cr以及造瘘3个月前后患侧肾盂尿液中尿mAlb/Cr、α1-MG/Cr、β2-MG/Cr、Trf/Cr、IgG/Cr、（mAlb+Trf+IgG）/Cr、（α1-MG+β2-MG）/Cr及分肾功能的变化，并分析各蛋白与分肾功能的相关性。结果 肾穿刺造瘘，3个月后低分肾功能组（DRF<22.1%）中mAlb/Cr、α1-MG/Cr、（mAlb+Trf+IgG）/Cr、（α1-MG+β2-MG）/Cr明显高于高分肾功能组（DRF≥22.1%），P值分别为0.035、0.005、0.035、0.002。肾盂造瘘3个月后患肾DRF显著改善（P<0.01），患肾尿液中α1-MG/Cr、IgG/Cr、（α1-MG+β2-MG）/Cr明显降低（P值分别为0.025、0.035、0.022），患肾DRF与α1-MG/Cr存在负相关（r=-0.436，P<0.05）。结论 儿童重度肾积水肾造瘘术后肾功能损害越严重，肾小球及肾小管损伤越严重。肾盂造瘘能明显改善儿童重度肾积水分肾功能及肾小球基底膜膜孔构型，肾功能恢复主要是肾小管功能恢复。尿α1-MG可以作为评估肾小管功能恢复的敏感指标，患肾肾盂尿液α1-MG的测定是小儿重度肾积水患肾功能评价的一项有临床价值的指标。
- Abstract:
- Objective To explore the clinical significance of pelvic urine microalbumin (mAlb), α1-microglobulin (α1-MG), β2-microglobulin (β2-MG), transferrin (Trf) and immunoglobulin G (IgG) with different molecular weight in children with severe hydronephrosis after percutaneous nephrostomy and analyze their correlation with renal function. Methods From March 2017 to October 2020, a total of 17 children hospitalized in the urology department of Children’s Hospital of Zhejiang University with unilateral severe hydronephrosis undergoing percutaneous nephrostomy were recruited.Renal function was assessed by renal radionuclide scanning and percutaneons nephrostomy surgery was performed.Pelvic urine was collected for urinary protein test.They were divided into two groups of lower DRF (n=11) and higher DRF (n=6) after 3 months according to DRF<22.1% and DRF ≥ 22.1%.The levels of affected renal pelvic urinary mAlb/Cr, α1-MG/Cr, β2-MG/Cr, Trf/Cr, IgG/Cr, (mAlb+Trf+IgG)/Cr and (α1-MG+β2-MG)/Cr were compared between two groups;changes of renal function, mAlb/Cr, α1-MG/Cr, β2-MG/Cr, Trf/Cr, IgG/Cr, (mAlb+Trf+IgG)/Cr and (α1-MG+β2-MG)/Cr were compared before and after percutaneous nephrostomy for 3 months.Correlation of urine proteins with renal function was analyzed. Results After percutaneous nephrostomy for 3 months, the levels of mAlb/Cr, α1-MG/Cr, (mAlb+Trf+IgG)/Cr and (α1-MG+β2-MG)/Cr were obviously higher in lower DRF group(DRF<22.1%) than in higher DRF group(DRF ≥ 22.1%) (P=0.035, P=0.005, P=0.035, P=0.002).There was obvious improvement of DRF after percutaneous nephrostomy for 3 months(P<0.01), the levels of urinary α1-MG/Cr, IgG/Cr and (α1-MG+β2-MG)/Cr of affected kidney declined markedly (P=0.025, P=0.035, P=0.022) and negative correlation existed between α1-MG/Cr and DRF (r=-0.436, P<0.05). Conclusion After percutaneous nephrostomy, the lower renal function the more damage of glomerulus and tubulars in children with severe hydronephrosis.Percutaneous nephrostomy is effective in improving DRF and membrane pore configuration of glomerular basement membrane in children with severe hydronephrosis.The improvement of renal function occurs mostly in recovery of renal tubules.Urinary α1-MG is a sensitive indicator of renal tubule improvement.And pelvic urine α1-MG may be employed as an valuable clinical indicator in evaluating affected renal function in children with severe hydronephrosis.
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备注/Memo
收稿日期:2020-12-27。
基金项目:国家重点研发计划（编号：2018YFC1002700）
通讯作者:唐达星,Email:tangdx0206@zju.edu.cn