原发性及狼疮性肾病综合征患者血清PAI-1、Lp(a)水平变化及其临床价值探讨

目的:探讨原发性及狼疮性肾病综合征患者纤溶酶原激活物抑制因子1(PAI-1)和血清脂蛋白a[Lp(a)]的水平变化及其检测的临床应用价值。方法:选取病理类型明确,临床初诊为肾病综合征的患者138例。其中原发性肾病综合征70例,为PNS组;系统性红斑狼疮继发性肾病综合征患者68例,为LNS组。同期选取本院健康体检正常者64例,为正常对照NC组。全自动生化分析仪检测各组血清Lp(a)和血脂等指标;酶联免疫吸附(Elisa)法测定血清PAI-1水平。结果:1与NC组比较,血清Lp(a)和PAI-1水平在PNS和LNS两组中均显著升高(P0.05),PNS组比LNS组升高更为明显,差异有统计学意义(P0.05);2LP(a)与PAI-1秩相关系数(rs)分析,在PNS组中r_s=0.328,P=0.006,LNS组中r_s=0.439,P=0.006;3二元logistic回归分析表明,LP(a)和PAI-1均是PNS和LNS的危险因素;4ROC曲线分析表明,血清Lp(a)、PAI-1对PNS和LNS诊断的ROC曲线下面积(AUC~(ROC))分别为0.895、0.874和0.848、0.813,两者联合检测对PNS和LNS诊断的AUC~(ROC)分别为0.947和0.919。结论:血清Lp(a)与PAI-1水平在PNS和LNS患者体内均明显升高,PNS患者升高更为显著;Lp(a)与PAI-1水平在PNS和LNS患者中均显著正相关;LP(a)和PAI-1均是PNS和LNS的危险因素,两者水平的变化与PNS和LNS的发生相关。联合检测Lp(a)与PAI-1水平对PNS和LNS的诊治具有一定的临床应用价值。

The Changes and Clinical Values of SerumLipoprotein (a) and PlasminogenActivator Inhibitor-1 in Primary and Lupus Secondary Nephrotic Syndrome

Objective:To explore the levels and clinical values of serum lipoprotein (a) [Lp (a)] and plasminogen activatorinhibitor-1 (PAI-1) in primary nephrotic syndrome (PNS) and lupus secondary nephrotic syndrome (LNS).Methods:138 nephroticsyndrome cases, including 70 PNS cases and 68 LNS cases whose renal pathological types were identified and 64 healthy physicalexamination people as normal controls (NC) in the same period were selected. Automatic biochemical analyzer detected the levels ofserumLp(a) and blood lipids. Enzyme-linked immunosorbent (Elisa) method tested the concentration of serumPAI-1.Results:Comparedwith the NC group, Lp (a) and PAI-1 were increased obviously in both PNS and LNS groups (P<0.05). They were higher in PNS groupthan in LNS group (P<0.05). The rank correlation coefficient of PAI-1 and Lp (a) in the PNS group was 0.328 (P=0.006), and in LNSgroup was 0.439 (P=0.006); Logistic regression analysis results showed that Lp(a) and PAI-1 were two risk factors in both group PNS andLNS. The areas under the ROC curve (AUCROC) of Lp (a) and PAI-1 was 0.895 and 0.874 to PNS, and to LNS patients was 0.848 and0.813 respectively. And the AUCROC of Lp (a) and PAI-1 combined detection to PNS and LNS was 0.947 and 0.919 respectively.Conclusion:Lp (a) and PAI-1 concentrations are increased obviously in both PNS and LNS patients, and they are higher in group PNSthan in group LNS. Lp (a) and PAI-1 levels were significantly positively correlated in patients with PNS and LNS. They could be two riskfactors in both PNS and LNS patients. The detection of themhas a higher clinical value in the diagnosis of PNS and LNS.