- 期刊
The Significance of Serum Alpha 2 Globulin Level in the Diagnosis of Nephrotic Syndrome
血清α2球蛋白對於腎變性症之診斷價值
摘要
就7個正常小孩，51個腎變性症小孩，25個急性腎臟炎小孩及22個急性風濕病小孩做血清蛋白濾紙泳動分析結果發現腎變性症之小孩呈現低血白蛋及低血丙蛋白。反此血清α2球蛋白量相當高，平均為39.92%。血清膽醇值正常的腎變性症小孩之血清beta球蛋白量比血清膽醇為高的腎變性症小孩為多。 急性腎臟炎小孩之血清蛋白泳動像呈現低血清白蛋白及高丙球蛋白。抗鏈球菌溶血素0值為高的急性腎臟炎小孩之血清丙球蛋白量較高。急性風濕病小孩之血清蛋白泳動像是相似急性腎臟炎之小孩之泳動像，但併有高血清抗鏈球菌溶血素0值者其血清α2球蛋白量較高。 腎變性症之血清白蛋白量最低，丙球蛋白量又最低，但α2球蛋白量最高。其他之疾病時α2球蛋白很少超過血清總蛋白量之24%，所以其診斷價值高。 如把低血白蛋白及高α2球蛋白同時做參考時，對於腎變性症之診斷價值比把高血α2球蛋白及低血球蛋白同時做參考時為高。 腎變性症併發營養失調症之－病例呈現低血白蛋白，高α2球蛋白及高丙球蛋白，所以低血丙球蛋白之診斷價值較低。
關鍵字
無資料並列摘要
Some children with acute glomerulonephritis may develop a transient nephrotic syndrome at the early stage of the disease and the nephrotic stage will disappear after a few days with the onset of diuresis. On the other hand, hematuria is characteristically absent in childhood nephrosis but can be present, and even gross hematuria has been described to develop occasionally. So at the early stage, the differental diagnosis between acute glomerulonephritis and nephrotic syndrome is sometimes difficult. Needle biopsy of the kidney may be valuable in diagnosing acute glomerulonephritis and in revealing the nature of the nephrotic syndrome. But even this procedure may at times fail to find the characteristic change of nephrotic syndrome. Moreover patients may refuse to accept the biopsy. Recent observations made by Bernstein et al confirmed the previous work on the serum electrophoretic pattern of these two conditions and correlated the findings with the change in renal biopsies. He found that the elevated alpha 2 globulin and increased gamma globulin fraction, when considered together is an accurate parameter in differentiating nephrotic syndrome from acute glomerulonephritis. They also quoted a case of acute glomerulonephritis associated with nephrotic syndrome at the early stage. The serum cellulose acetate electrophoretic pattern of this case never likes the pattern of childhood nephrotic syndrome, but likes the pattern of acute glomerulonephritis. The other conditions which may show the electrophoretic pattern of nephrotic syndrome are protein-losing enteropathy and some cases of burn, but these two conditions can clinically be easily differentiated from the nephrotic syndrome. The elevated serum cholesterol level may be helpful in the diagnosis of nephrotic syndrome but in some cases, especially when associated with malnutrition, the serum cholesterol level may be normal or low. Recently we have encountered a nine-year-old boy who suffered from severe malnutrition, proteinuria and low normal serum cholesterol level. His serum paper electrophoretic pattern showed low level of albumin, high alpha 2 globulin and elevated gamma globulin. The serum cholesterol level later raised to 302 mg per cent and the proteinuria disappeared after the treatment with steroid hormone. The high alpha 2 globulin level made us to believe that this is a case of nephrotic syndrome. We feel that magnitude of the elevation of serum alpha 2 globulin fraction when expressed in per cent of total protein might be the most simple and accurate parameter which differentiates nephrotic syndrome from other misleading conditions. The present paper is intended to analyse the significance of the elevated alpha 2 globulin fraction in differentiating nephrotic syndrome from acute glomerulonephritis. The electrophoretic pattern of acute rheumatic fever is also analysed for comparison.