尿IL-17水平检测对评估IgA肾病病情和治疗疗效的价值  

The Significance of Urine IL-17 Measurement in the Assessment of Disease Severity and Treatment Efficacy in IgA Nephropathy

作　　者：林芙君[1] 蒋更如[1] 邹军[1] 边帆[1] 姚瑶[1] 

机构地区：[1]上海交通大学医学院附属新华医院肾脏内科,上海200092

出　　处：《中国中西医结合肾病杂志》2014年第5期404-407,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：上海市卫生局青年科研基金资助项目(No.Z011Y108);上海交通大学晨星青年学者奖励计划项目(2013年度)

摘　　要：目的:探讨尿白细胞介素-17(IL-17)检测对评估IgA肾病(IgAN)病情严重程度和治疗疗效中的价值。方法:应用酶联免疫吸附法(ELISA)检测79例原发性IgAN患者治疗前后的尿IL-17水平,分析患者治疗前尿IL-17水平与临床指标、牛津病理分型[系膜细胞增生(M)、内皮细胞增生(E)、节段硬化或黏连(S)和肾小管萎缩/间质纤维化(T)]的相关性;比较不同治疗方案下患者治疗前后尿IL-17水平的变化以及与疾病转归的关系。结果:IgAN患者治疗前尿IL-17的水平较正常对照显著升高并且与尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的水平和24 h尿蛋白呈正相关、与eGFR呈负相关。根据牛津病理分型,E1组患者的尿IL-17水平显著高于E0组,T1组和T2组患者的尿IL-17水平分别显著高于T0组,M0组与M1组、S0组与S1组、T1组与T2组的尿IL-17水平差异均无统计学意义。治疗6个月后,在单用血管紧张素转换酶抑制剂(ACEI)治疗的患者中治疗显效组的尿IL-17水平较治疗前显著下降,而治疗无效组的尿IL-17水平较治疗前无显著下降;ACEI联合糖皮质激素治疗的患者中治疗有效组和无效组在治疗后的尿IL-17水平较治疗前均显著下降。结论:尿IL-17水平在评估IgAN患者的病情和疗效预判方面具有潜在的临床实用价值。Objective：To evaluate the level of urine IL-17 in IgAN patients and its significance in reflecting disease activi-ty and treatment efficacy. Methods：Urine IL-17 levels of 79 patients with biopsy-proven IgAN before and after treatment （ ACEI with or without corticosteroids） were measured by enzyme-linked immunosorbent assay （ELISA）. The correlation between pre-treatment urine IL-17 levels and clinical/renal pathological parameters were analyzed; The difference of urine IL-17 levels before and after treatment were compared in two groups of IgAN patients with different treatments. Results：Before treatment, urine IL-17 levels of IgAN patients were significantly elevated compared with normal controls and urine IL-17 levels were significantly correlated with urine level of neutrophil gelatinase-associated lipocalin （ NGAL） , 24 h proteinuria and eGFR. Using the Oxford classification system, we found that urine IL-17 levels of those patients with E1 were significantly higher than those with E0, and urine IL-17 levels of those patients with T1 and T2 were respectively higher than those with T0. After 6 months of treatment, in patients only trea-ted with ACEI, post-treatment urine IL-17 levels in patients with complete or partial remission were significantly lower compared with pre-treatment levels, while urine IL-17 levels in patients who didn＇t respond to ACEI didn＇t change significantly before and after treatment;However, in patients treated with ACEI and corticosteroids, post-treatment urine IL-17 levels of both remission and treatment-resistant patient groups were significantly lower compared with pre-treatment levels. Conclusion：Urine IL-17 level is a useful biological marker for the assessment of disease severity and treatment efficacy of IgAN patients.

关 键 词：也页 IGA肾病 白细胞介素-17 尿液 生物学标记 

分 类 号：R692.3[医药卫生—泌尿科学]