摘要目的 探讨血半胱氨酸蛋白酶抑制剂C(血Cys-C)、尿半胱氨酸蛋白酶抑制剂C(尿Cys-C)、尿视黄醇结合蛋白(RBP)、尿中性粒细胞明胶酶相关载脂蛋白(NGAL)在早期评估多发性骨髓瘤(MM)肾损害中的作用及在MM不同病理类型肾损害中的变化特点.方法 根据肾少球滤过率估计值将MM患者分成两组,A组为肾功能正常组,B组为肾功能损害组.以同期性别和年龄相匹配的健康志愿者为对照.检测患者血Cys-C、尿Cys-C、尿RBP、尿NGAL及血清肌酐(Scr)、尿微量蛋白(MAU)、尿α1-微球蛋白(α1-MG),同时对血Cys-C、尿Cys-C、尿RBP、尿NGAL异常且有意愿的患者行肾穿刺活检.结果 ①A组MM患者与健康对照组相比,血Cys-C、尿RBP、尿Cys-C、尿NGAL均高于健康对照组(P值均＜0.05).6例实验指标异常的A组患者行肾穿刺活检术,活检结果提示均有不同程度的肾损害,且血Cys-C、尿Cys-C、尿RBP、尿NGAL异常率分别为66.7％、66.7％、66.7％、83.3％.②24例实验指标异常的MM患者行肾穿刺活检术,其中淀粉样变性组6例,管型肾病(CN)组12例,免疫球蛋白沉积病(MIDD)组6例.CN组与MIDD组、淀粉样变性组相比,尿Cys-C、尿NGAL明显升高(P＜0.05).MIDD组与CN组、淀粉样变性组相比,尿RBP明显升高(P =0.043).淀粉样变性组与CN组、MIDD组相比,MAU明显升高(P =0.006).结论 与传统指标相比,血Cys-C、尿Cys-C、尿RBP、尿NGAL能更有效地早期评估MM患者肾损害.淀粉样变性组患者MAU明显升高,CN组患者尿Cys-C、尿NGAL明显升高,MIDD组患者尿RBP明显升高.

abstractsObjective To investigate the value of serum cystatin C(Cys-C),urinary Cys-C,urinary retinol binding protein (RBP) and urinary neutrophil gelatinase-associated lipocalin (NGAL) in the early assessment of multiple myeloma (MM) and their characteristic changes in different pathological types of renal impairment.Methods According to glomerular filtration rate (eGFR),the patients were divided into two groups,of which marked group A with normal renal function,the other marked group B with abnormal renal function.Sixty healthy subjects were chosen as control.Detection of the serum Cys-C,urinary RBP,urinary Cys-C,urinary NGAL,serum creatinine (Scr),urinary microalbumin (MAU) and urinary α1-microglobulin (α1-MG) were performed.Renal biopsy was carried out for patients who had abnormal serum Cys-C,urinary Cys-C,urinary RBP,urinary NGAL and were willing to accept further test.Results Compared with healthy controls,the serum Cys-C,urinary RBP,urinary Cys-C,urinary NGAL of group A were significantly higher than that of healthy controls.Six group A patients received renal biopsy,and varying degrees of renal damage were discovered.The serum Cys-C,urinary RBP,urinary Cys-C and urinary NGAL positive rate were 66.7％,66.7％,66.7％ and 83.3％,respectively.Of twenty-four cases received biopsy after abnormal examination results were shown,six turned out to be amyloidosis,twelve cast nephropathy (CN) and 6 monoclonal immunoglobulin deposition disease (MIDD).Compared with MIDD and amyloidosis,the urinary Cys-C and NGAL of the CN group are significantly higher (P ＜ 0.05).Compared with CN and amyloidosis,urinary RBP of MIDD is significantly higher (P =0.043).Compared with MIDD and CN,the MAU of amyloidosis is significantly higher (P =0.006).Conclusion Compared with the conventional indicators,serum Cys-C,urinary Cys-C,RBP and NGAL are more sensitive in early assessment of MM patients with renal damage.The MAU is higher in amyloid,the urinary Cys-C and urinary NGAL are significantly elevated in CN,the urinary RBP is significantly elevated in MIDD.