血管生成素样蛋白4评估和预测膜性肾病治疗效果
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摘要
目的探讨血液及尿液血管生成素样蛋白4(angiopoietin-like 4,Angptl4)评估及预测膜性肾病治疗效果的可行性。方法 37例原发性膜性肾病患者分成两组,分别接受甲泼尼龙联合环磷酰胺和甲泼尼龙联合环孢素A治疗6个月。分别检测治疗前及治疗后6个月内不同时间血液及尿液Angptl4水平、尿总蛋白、血浆白蛋白及丙氨酸转氨酶等生化指标。用SPSS 24.0及Graphpad Prism 5.0软件统计及制图。结果 (1)两组患者的治疗有效率相当;(2)Pearson线性相关性分析显示尿总蛋白与尿液Angptl4呈线性相关;(3)尿总蛋白以及尿Angptl4随时间的变化具有统计意义,且尿Angptl4在治疗早期的变化更显著;(4)血浆Angptl4水平无明显变化。结论尿Angptl4较尿总蛋白能更早的评估和预测膜性肾病治疗效果。
Objective To investigate the feasibility of serum and urine angiopoietin-like 4(Angptl4) for evaluating and predicting efficacy for membranous nephropathy. Methods A total of 37 patients with primary membranous nephropathy was divided into two groups, receiving methylprednisolone combined with cyclophosphamide and methylprednisolone combined with cyclosporine A respectively for six months. All the patients were detected for serum and urine Angptl4 levels,total urine proteinand biochemical indicators such as plasma albumin and alanine aminotransferaseat various time points before treatment and within 6 months after treatment. Statistics and Mapping were done with software SPSS 24.0 and Graphpad Prism 5.0. Results(1) The effective rate sin the two groups was comparable.(2) Pearson linear correlation analysis showed that total urine protein and urine Angptl4 were linearly correlated.(3)The changes of total urine protein and urine Angptl4 with time were statistically significant,and the change of urine Angptl4 in the early stage of treatment was more obvious.(4) There were no significant changes in plasma Angptl4 levels. Conclusions Compared with total urine protein,urine Angptl4 can earlier evaluate and predict efficacy for membranous nephropathy.
Objective To investigate the feasibility of serum and urine angiopoietin-like 4(Angptl4) for evaluating and predicting efficacy for membranous nephropathy. Methods A total of 37 patients with primary membranous nephropathy was divided into two groups, receiving methylprednisolone combined with cyclophosphamide and methylprednisolone combined with cyclosporine A respectively for six months. All the patients were detected for serum and urine Angptl4 levels,total urine proteinand biochemical indicators such as plasma albumin and alanine aminotransferaseat various time points before treatment and within 6 months after treatment. Statistics and Mapping were done with software SPSS 24.0 and Graphpad Prism 5.0. Results(1) The effective rate sin the two groups was comparable.(2) Pearson linear correlation analysis showed that total urine protein and urine Angptl4 were linearly correlated.(3)The changes of total urine protein and urine Angptl4 with time were statistically significant,and the change of urine Angptl4 in the early stage of treatment was more obvious.(4) There were no significant changes in plasma Angptl4 levels. Conclusions Compared with total urine protein,urine Angptl4 can earlier evaluate and predict efficacy for membranous nephropathy.
引文
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[14] 李梦.Angptl4在体内和体外足细胞损伤中的作用研究[D].浙江大学,2015.
[15] 戴如凤,方晓燕,李国民,等.原发性肾病综合征患儿血清及尿液中血管生成素样蛋白3和4的临床意义[J].中华肾脏病杂志,2015,31(10):721-728.
[2] Kersten S,Lichtenstein L,Steenbergen E,et al.Caloric restriction and exercise increase plasma ANGPTL4 levels in humans via elevated free fatty acids[J].Arterioscler Thromb Vasc Biol,2009,29(6):969-974.
[3] Clement LC,Avila-casado C,Mace C,et al.Podocyte-secreted angiopoietin-like-4 mediates proteinuria in glucocorticoid-sensitive nephrotic syndrome[J].Nat Med,2011,17(1):117-122.
[4] Chugh SS,Mace C,Clement LC,et al.Angiopoietin-like 4 based therapeutics for proteinuria and kidney disease[J].Front Pharmacol,2014,5:23.
[5] Vaziri ND,Moradi H.Dual role of circulating angiopoietin-like 4 (ANGPTL4) in promoting hypertriglyceridemia and lowering proteinuria in nephrotic syndrome[J].Am J Kidney Dis,2014,64(4):495-498.
[6] Mercadal L.Membranous nephropathy[J].Nephrol Ther,2013,9(7):507-517.
[7] Chen Y,Schieppati A,Chen X,et al.Immunosuppressive treatment for idiopathic membranous nephropathy in adults with nephrotic syndrome[J].Cochrane Database Syst Rev,2014,10:D4293.
[8] Alexopoulos E,Papagianni A,Tsamelashvili M,et al.Induction and long-term treatment with cyclosporine in membranous nephropathy with the nephrotic syndrome[J].Nephrol Dial Transplant,2006,21(11):3127-3132.
[9] Kosmadakis G,Filiopoulos V,Smirloglou D,et al.Comparison of immunosuppressive therapeutic regimens in patients with nephrotic syndrome due to idiopathic membranous nephropathy[J].Ren Fail,2010,32(5):566-571.
[10] Li JS,Chen X,Peng L,et al.Angiopoietin-like-4,a potential target of tacrolimus,predicts earlier podocyte injury in minimal change disease[J].PLoS One,2015,10(9):e137049.
[11] Chugh SS,Clement LC,Mace C.New insights into human minimal change disease:lessons from animal models[J].Am J Kidney Dis,2012,59(2):284-292.
[12] Tran TH,J HG,Greenfeld C,et al.Overview of current and alternative therapies for idiopathic membranous nephropathy[J].Pharmacotherapy,2015,35(4):396-411.
[13] Lai WL,Yeh TH,Chen PM,et al.Membranous nephropathy:a review on the pathogenesis,diagnosis,and treatment[J].J Formos Med Assoc,2015,114(2):102-111.
[14] 李梦.Angptl4在体内和体外足细胞损伤中的作用研究[D].浙江大学,2015.
[15] 戴如凤,方晓燕,李国民,等.原发性肾病综合征患儿血清及尿液中血管生成素样蛋白3和4的临床意义[J].中华肾脏病杂志,2015,31(10):721-728.