尿液粘附分子:活动性狼疮肾炎的标志物  

Urinary soluble intercellular adhesion molecule-1 and vascular cellular adhesion molecule-1: potential biomarkers of active lupus nephritis

作　　者：吴春益 杨满球 周展眉[1] 冯晓丹 钟晓红[1] 崔爽[1] 吴丽玲[1] 曹维[1] 

机构地区：[1]南方医科大学南方医院肾内科,广东广州510515 [2]广州市开发区医院肾内科,广东广州510730

出　　处：《南方医科大学学报》2015年第9期1272-1276,1282,共6页Journal of Southern Medical University

基　　金：国家自然科学基金(81570619);国家自然科学基金青年基金(81200502);广东省优秀博士学位论文作者资助项目(SYBZZXM201322)~~

摘　　要：目的研究狼疮性肾炎(LN)患者尿液和肾组织中细胞间粘附分子(ICAM-1)和血管粘附分子(VCAM-1)的变化情况,探讨尿s ICAM-1和VCAM-1水平与肾脏活动性病理改变的相关性。方法选取我院收治经肾穿刺活检确诊为LN的患者92例。并同时纳入20例门诊健康体检者做为对照。收集肾穿刺活检当日患者的尿液,Elisa法检测尿液s ICAM-1和VCAM-1水平。免疫组织化学染色法检测肾组织中ICAM-1和VCAM-1的表达情况。ROC曲线分析尿s ICAM-1和VCAM-1在预测活动性LN中的敏感性和特异性。结果与非活动性LN和正常人相比,活动性LN患者尿s ICAM-1和VCAM-1水平显著升高,肾脏ICAM-1和VCAM-1表达也显著增加并与尿s ICAM-1和VCAM-1水平成正相关关系。尿s ICAM-1的ROC曲线分析显示,曲线下面积为0.874,尿s ICAM-1值>1095.00 pg/mg creatinine诊断为活动性LN,特异性94.5%,敏感性78.9%。尿VCAM-1的ROC曲线分析显示,曲线下面积为0.882,尿VCAM-1值>898.11 pg/mg creatinine诊断为活动性LN,特异性98.2%,敏感性66.7%。结论尿s ICAM-1和VCAM-1水平可作为判断LN活动性的生物标志物。检测这两个指标可帮助观察LN患者的病情变化,为个体化治疗提供新依据。Objective To determine the levels of urinary soluble intercellular adhesion molecule- 1（s ICAM- 1） and vascular cellular adhesion molecule-1（VCAM-1） in patients with lupus nephritis（LN）, and explore their correlation with renal disease activity. Methods Urine samples were collected from 92 renal biopsy- proven LN patients and 20 healthy controls. Renal disease activity was determined according to the ISN/RPS 2003 Revised Classification of Lupus Nephritis. The urine levels of s ICAM-1 and VCAM-1 were detected by enzyme-linked immunosorbent assay, and the expressions of intrarenal ICAM-1 and VCAM- 1 were evaluated by immunohistochemisty staining. Results Urinary s ICAM- 1 and VCAM- 1 levels were elevated in LN patients compared with the controls. Significantly higher levels of urinary s ICAM-1 and VCAM-1 were found in patients with active LN, who had also significantly increased intrarenal expressions of ICAM-1 and VCAM-1 compared with patients in remission. A strong positive correlation was noted between intrarenal expression and urine levels of ICAM-1 and VCAM-1.The receiver- operating characteristic（ROC） curve of urine s ICAM- 1 showed tan area under ROC curve of 0.874 for all participants in the test. A cutoff of 1095.00 pg/mg creatinine yielded a good sensitivity（0.945） and specificity（0.789）. The ROC curve of urine VCAM- 1 showed an area under ROC of 0.882 for all the participants, and a cutoff of 898.11 pg/mg creatinine yielded a good sensitivity（0.982） and specificity（0.667）. Conclusion Urine s ICAM- 1 and VCAM- 1 levels are positively correlated with their intrarenal expressions and reflect the activity of the nephritis, and therefore they may serve as potential biomarkers for early diagnosis of active LN.

关 键 词：活动性狼疮肾炎 生物标志物 粘附分子 

分 类 号：R593.242[医药卫生—内科学]