梗阻性肾病患者血清中Ⅲ型前胶原及Ⅲ型前胶原氨基末端肽与肾脏纤维化的相关性

Association of procollagen type Ⅲ and N-terminal peptide of procollagen type Ⅲ in serum with renal fibrosis in patients with obstructive nephropathy

摘要:

目的：探讨梗阻性肾病患者血清中PCⅢ及PCⅢ氨基末端肽浓度的变化与肾组织纤维化的相关性。方法：选取2012年1月至2017年12月在我院就诊的78例梗阻性肾病患者和30名健康体检者对照进行研究。采用放射免疫法测定血清Ⅲ型前胶原（PCⅢ）及Ⅲ型前胶原氨基末端肽（PⅢNP）水平，取得肾组织标本进行HE和Masson染色，光镜下观察肾纤维化程度；Spearman分析PCⅢ及PⅢNP与肾组织纤维化的相关性；建立logistic回归模型根据PCⅢ和PⅢNP水平探讨肾纤维化的危险因素。ROC曲线预测PCⅢ及PⅢNP在Ⅱ度肾纤维化的诊断灵敏度和特异度。结果：随着肾纤维化程度的升高，患者PCⅢ和PⅢNP的水平逐渐升高（P＜0.01）。PCⅢ和PⅢNP水平与肾纤维化程度均有良好的相关性（rs=0.82０，P=0.000；rs=0.806，P=0.000）。PCⅢ对Ⅱ度肾纤维化预测的灵敏度和特异性分别为95.45%、83.93%，ROC曲线下面积0.96，95%CI=0.890~0.991；PⅢNP预测的灵敏度和特异性分别为86.36%、92.86%，ROC曲线下面积0.93，95%CI=0.849~0.976；两者均有较高的预测价值。PCⅢ：OR值为1.151（95%CI=1.035～1.280，P=0.009）；PⅢNP：OR值为1.198（95%CI=1.039～1.380，P=0.013）。结论：血清中PCⅢ及PⅢNP水平与肾脏纤维化程度呈正相关，两者对重度肾纤维化有良好的预测价值，具有临床推广价值。

Abstract:

Objective：To investigate the changes in serum levels of procollagen type Ⅲ（PCⅢ） and N-terminal peptide of PCIII （PII－INP） and their association with renal fibrosis in patients with obstructive nephropathy. Methods：A total of 78 patients with obstruc－tive nephropathy who were treated in our hospital from January 2012 to December 2017 and 30 individuals who underwent physical examination were enrolled. Radioimmunoassay was used to measure the serum levels of PCⅢ and PⅢNP. Renal tissue samples were collected for HE and Masson staining. The degrees of renal fibrosis were observed under a light microscope. The Spearman analysis was used to investigate the association of PCⅢ and PⅢNP with renal fibrosis. A logistic regression model was used to analyze the risk factors for renal fibrosis based on the levels of PCⅢ and PⅢNP. The receiver operating characteristic（ROC） curve was used to predict the sensitivity and specificity of PCⅢ and PⅢNP in the diagnosis of degree Ⅱ renal fibrosis. Results：The levels of PCⅢ and PⅢNP gradually increased with the increase in the degree of renal fibrosis（P<0.01）. The levels of PCⅢ and PⅢNP were positively correlated with the degree of renal fibrosis（rs=0.820 and 0.806，P=0.000 and 0.000）. PCⅢ had a sensitivity of 95.45%，a specificity of 83.93%，and an area under the ROC curve（AUC） of 0.96（95%CI=0.890 to 0.991） in predicting degreeⅡ renal fibrosis；PⅢNP had a sensitivity of 86.36%，a specificity of 92.86%，and an area under the ROC curve（AUC） of 0.93（95%CI=0.849 to 0.976） in pre－dicting degreeⅡ renal fibrosis；both of them had a high predictive value. PCⅢ（OR=1.151，95%CI=1.035 to 1.280，P=0.009） and PⅢNP（OR=1.198，95%CI＝1.039 to 1.380，P=0.013） were risk factors for renal fibrosis. Conclusion：The serum levels of PCⅢ and PⅢNP are positively correlated with the degree of renal fibrosis，and both of them have a good value in predicting severe renal fibrosis and thus hold promise for clinical application.