The Discussion Of Al-antitrypsin And Haptoglobin For Predicting Response To Glucoeorticoid Therapy In Children With Primary Nephrotic Syndrome

Objective: To discuss the curative effect of Haptoglobin(HP) and alpha 1-antitrypsin(AAT) as steroid resistant predictors in children with primary nephrotic syndrome(PNS) by detecting their express level in serum and urine.Methods: According the negative Urine protein by the treatment of glucocorticoid,84 children diagnosed as PNS in September 2012 to January 2014 were divided into steroid sensitive nephrotic syndrome(SSNS) group(n=58) and steroid resistant nephrotic syndrome(SRNS) group(n=26); A random sample of 40 healthy children as control group. Collected blood, urine samples to detect the level of each sample of HP and AAT by ELISA(enzyme-linkedimmunosorbent assay) kit before treatment and SSNS group and SRNS group were treated for 1 weeks, 4 weeks respectively. Receiver operating characteristic curve(ROC curve) evaluated the prediction efficiency of steroid treatment for PNS by HP and AAT。the biochemical factor levels of Cr, TP, Alb, Tcho,24 h UP were tested.Results: The results: 1. The group resultsChildren included in the study 84 cases of PNS. Adequate oral hormone therapy four weeks, urine protein was negative by that steroid-sensitive nephrotic syndrome(SSNS) group of 58 cases, urine protein that is not negative by steroid-resistant nephrotic syndrome(SRNS) group of 26 cases.2. Case serum, urine compare expression levels of haptoglobin(1) Before corticosteroids, PNS HP serum concentration levels were significantly higher, the difference was statistically significant(P <0.05); dynamic monitoring SSNS group before their treatment, one week and four weeks of treatment concentration the difference was not statistically significant level(P> 0.05), before SRNS group their treatment, one week and four weeks of treatment had no statistically significant difference in levels(P> 0.05); but SRNS group and SSNS group, SRNS group HP compared SSNS serum concentration levels before treatment,one week and four weeks of treatment were significantly increased over the same period, the difference was statistically significant(P <0.05)).(2) prior to glucocorticoid therapy, PNS children with urinary HP / Cr levels were significantly higher, the difference was statistically significant(P <0.05); but in between SSNS and SRNS group difference was not statistically significant(P> 0.05), SSNS and SRNS when urinary HP / Cr before treatment, one week and four weeks of treatment, within SSNS and SRNS group difference was not statistically significant. 3. Case serum, urine α1 antitrypsin expression levels compare(1) Before corticosteroids, PNS serum AAT levels than the control group showed no significant difference(P <0.05); SRNS group than SSNS serum AAT before hormone treatment, one week and four weeks of treatment concentration levels between groups and within-group differences were not statistically significant(P> 0.05)(2) Before corticosteroids, PNS children with urinary AAT / Cr levels were significantly higher, the difference was statistically significant(P <0.05); dynamic monitoring SSNS group before their treatment, one week and four weeks of treatment no significant difference in levels(P> 0.05), before SRNS group its treatment, one week and four weeks of treatment had no statistically significant difference in levels(P> 0.05); but SRNS group and SSNS group, SRNS group than SSNS urinary AAT / Cr levels before treatment, one week and four weeks of treatment were significantly increased over the same period, the difference was statistically significant(P <0.05)).4. PNS serum, urine haptoglobin, α1-antitrypsin expression levels for predicting SRNS ROC curve analysis.HP to SSNS and serum concentrations of SRNS group do the ROC curve, the area under the curve(AUC) was 0.904, when the value of serum HP interception 37.935 mg / ml, the highest performance prediction, the sensitivity was 92.3%, specificity was 86.2%(Youden Index 78.5%); two urine AAT / Cr as ROC, AUC was 0.899, while urine AAT / Cr interception is 0.0696, the highest performance prediction, the sensitivity of 100% and a specificity of 79.3%(Youden index 79.3%). Joint collaboration between ROC, its AUC 0.971, sensitivity 92.3%, specificity was 96.6%(Youden index 88.9%), with better predictive performance. In conclusion:1, the beginning of PNS disease, serum HP, urine AAT / Cr detect expression levels, may serve as indicators of the degree of kidney damage in children, in the early onset of PNS in children with steroid-resistant tips may guide clinical Personalized Medicine.2, in front of hormone therapy in children with nephrotic syndrome, monitor serum HP higher than 37.935 mg / ml, suggestive of hormone-resistant(AUC 0.904, sensitivity 92.3%, specificity 86.2%).3, in front of hormone therapy in children with nephrotic syndrome, monitoring urine AAT / Cr greater than 0.0696, suggesting possible steroid-resistant(AUC of 0.899, sensitivity of 100% and a specificity of 79.3%).4, haptoglobin, α1-antitrypsin are both acute-phase inflammatory response protein, which may be at the protein level of the reaction product of resistance mechanisms in children with SRNS, the two combined detection of serum and urine markers to predict the effectiveness of a better(AUC 0.971, sensitivity 92.3%, specificity 96.6%).