血清白细胞介素-18水平升高可预测IgA肾病患者的疾病进展  

Elevated serum interleukin-18 levels may predict disease progression in IgA nephropathy

作　　者：施蓓莉[1] 倪兆慧[1] 周敏捷[1] 曹励欧[1] 牟姗[1] 王琴[1] 张敏芳[1] 吴青伟[1] 戴慧莉[1] 方炜[1] 严玉澄[1] 钱家麒[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科,200127

出　　处：《上海医学》2012年第1期48-52,共5页Shanghai Medical Journal

基　　金：973课题(2012CB517602);上海市高校选拔培养优秀青年教师科研专项基金(jdy09025);上海市科学技术委员会中医药现代化专项基金(09dZ1973600)及上海市科学技术委员会基础重点项目(10JC1410100)资助

摘　　要：目的探讨IgA肾病(IgAN)患者的血清白细胞介素(IL)-18水平与肾脏预后之间的关系。方法采用酶联免疫吸附法(ELISA)检测36例IgAN患者治疗前后的血清IL-18水平,并对其进行前瞻性随访,评价IL-18与患者肾脏预后之间的关系。结果 IgAN患者血清IL-18水平为(360.3±25.2)ng/L,显著高于健康对照者的(51.2±8.9)ng/L(P<0.01)。糖皮质激素治疗后,IgAN患者血清IL-18水平为(119.6±21.8)ng/L,较治疗前显著降低(P<0.001)。对lgAN患者进行19.0～62.4个月的前瞻性随访,中位随访期为38.7个月。随访期间14例(38.9%)患者出现肾功能减退。肾功能减退组患者治疗前、后IL-18水平分别为(364.45±40.25)、(132.44±32.40)ng/L,均显著高于肾功能稳定组的(353.67±16.36)、(99.41±24.14)ng/L(P值均<0.05)。Spearman相关分析显示,与随访期间肾小球滤过率(eGFR)降低的相关因素包括治疗前患者血清IL-18(r=-0.127,P=0.045)、血清肌酐(r=0.442,P=0.007)和eGFR(r=-0.845,P<0.001)。将以上所有变量纳入Logistic回归方程进行分析,治疗前IL-18水平(β=0.346,P=0.033)、eGFR(β=-0.41,P=0.013)是预测IgAN患者eGFR减退与否的重要危险因素。Kaplan-Meier生存分析结果显示,治疗前血清IL-18水平较高者的肾脏预后较差(P=0.008)。Cox回归分析进一步证实,治疗前血清IL-18水平(β=0.984,95%CI为0.926～1.042,P<0.001)及治疗前eGFR减退(β=1.021,95%CI为0.999～1.043,P=0.045)是预测肾脏预后的独立危险因素。结论治疗前IL-18水平升高可能是预测IgAN患者肾脏疾病进展的重要生物学标志物之一。Objective To investigate the relationship between serum interleukin 18 （IL-18） levels and prognosis of patients with IgA nephropathy （IgAN）. Methods The serum IL-18 levels of 36 IgAN patients were measured by ELISA before and after treatment, and the prospective follow-up was carried out to evaluate the relationship between IL-18 levels and prognosis. Results The serum IL-18 level in IgAN patients was significantlyhigher than that in healthy controls （[360.3±25.2] ng/L vs. [51.2±8.91 ng/L, P〈0.01 ）. After treatment with glucocorticoid, the serum IL-18 level in IgAN patients was decreased by （119. 6±21. 8） ng/L, which was significantly lower than that of pretreatment （P〈0. 001 ）. During a median follow-up of 38. 7 （19. 0-62. 4）months, 14 patients （38.9%） had a declined renal function. Compared with those who had a stable renal tunctlon, serum IL-18 levels before and after treatment were significantly increased in patients with renal function deterioration （[364.45±40. 25]ng/L vs. [353.67± 16. 36] ng/L, [132.44± 32. 40]ng/L vs. [99.41 ± 24.14]ng/L, both P〈0.05）. Spearman correlation analysis showed that baseline serum IL-18 level （r =-0. 127, P=0. 045）, serum creatinJne （SCr, r = 0. 442, P = 0. 007） and glomerular filtration rate （eGFR, r = - 0. 845, P〈 0. 001） were correlated with the decline of eGFR during the follow-up. Logistic regression analysis showed that baseline IL-18 levels （β=0.346, P=0.033） and eGFR （β= -0.41, P=0.013） were important risk predictorsof eGFR decrease in IgAN patients. Kaplan-Meier analysis found that patients with elevated serum IL-18 levels had a poorer renal prognosis （P=0. 008）. Cox regression analysis further confirmed that elevated serum IL-18 levels （β=0.984, 95%C1： 0.926- 1. 042, P〈0.001） and decreasedeGFR （β=1.021, 95%C1： 0.999-1.043, P=0. 045） before treatment were independent risk factors of disease progression. Conclusion Elevation of serum IL-18 levels prior to treatment may serve as an i

关 键 词：IGA肾病 白细胞介素-18 疾病进展 

分 类 号：R692.3[医药卫生—泌尿科学]