狼疮性肾炎患者血清白细胞介素-17和白细胞介素-23表达及意义  

Expression and Significance of Serum Interleukin-17 and Interleukin-23 in Patients with Lupus Nephritis

作　　者：何援军[1] 黄德东[2] 来晓维[2] 施洁[2] 

机构地区：[1]浙江省衢化医院肾内科,衢州324000 [2]解放军第一一七医院感染科,杭州310013

出　　处：《中华临床免疫和变态反应杂志》2016年第2期117-124,共8页Chinese Journal of Allergy & Clinical Immunology

基　　金：国家自然科学基金(31200655);浙江省自然科学基金(LY15H190001)

摘　　要：目的探究血清白细胞介素(interleukin,IL)-17和IL-23在研究狼疮性肾炎(lupus nephritis,LN)病情活动评估及疗效预测中的作用。方法 LN组患者54例,其中活动组29例,稳定组25例;健康对照组20例。采用酶联免疫吸附试验(ELISA)测定血清IL-17、IL-23水平,收集整理LN患者的临床资料及实验室数据。29例活动组LN进行正规治疗并随访6个月,评估疗效。分析IL-17、IL-23在LN病情活动评估及疗效预测中的作用。结果 LN组与健康对照组年龄、男女比例的差异无统计学意义。LN活动组IL-17水平为(9.58±1.38)×10-15gL,高于LN稳定组[(6.20±1.04)×10-15gL](P<0.001),也高于健康对照组[(6.18±0.98)×10-15gL](P<0.001)。LN活动组IL-23水平为(175.7±25.67)×10-15gL,高于LN稳定组[(132.6±19.54)×10-15gL](P<0.001),也高于健康对照组[(114.6±19.70)×10-15gL](P<0.001)。LN活动组经过治疗后,IL-17、IL-23水平均显著下降(P<0.01)。LN活动组经治疗后完全缓解组、部分缓解组及未缓解组IL-23基线水平差异有统计学意义,其中完全缓解组IL-23基线水平较部分缓解低(P<0.001),也低于未缓解组(P=0.003)。IL-17与C3呈负相关(r=-0.35,P=0.002);IL-17与系统性红斑狼疮疾病活动指数呈正相关(r=0.61,P<0.001);IL-23与系统性红斑狼疮疾病活动指数呈正相关(r=0.56,P<0.001)。IL-17与病理急性指数相关性(r=0.47,P<0.01)较IL-23与病理急性指数相关性(r=0.39,P<0.05)高。受试者工作特征(ROC)曲线分析发现:IL-17、IL-23可作为评估LN临床病情活动(系统性红斑狼疮疾病活动指数>9)的指标,IL-17可作为评估LN病理急性指数>8的指标,IL-23可作为预测活动性LN疗效的指标。结论 IL-17、IL-23可能在LN致病中起重要作用,IL-17可作为评估LN疾病活动及病理急性指数的指标,IL-23可作为预测LN活动期治疗疗效的指标。Objective To investigate the roles of serum interleukin（ IL）-17 and IL-23 in evaluation and predicting the activity of lupus nephritis,（ LN） and the prediction of therapeutic response to immunosuppressive treatment by comparing between IL-17 and IL-23 and clinical data of LN. Methods Fifty-four patients with LN and 20healthy volunteers were enrolled into this study. Serum levels of serum IL-17 and IL-23 were detected by ELISA and clinical data were collected in patients with LN. Twenty-nine patients with active LN accepted immunosuppressive therapy and followed up for 6 months. The roles of IL-17 and IL-23 in evaluating the activity of LN and predicting the therapeutic response to immunosuppressive treatment were analyzed. Results The difference of age and gender ration between LN patients and healthy controls was not significant at baseline.Baseline level of IL-17 is higher in patients with active LN [（ 9. 58 ± 1. 38） × 10- 15gL]compared to patients with inactive LN [（ 6. 20 ± 1. 04） × 10- 15gL]and controls [（ 6. 18 ± 0. 98） × 10^（- 15）gL]（ P 〈0. 001）; Baseline level of IL-23 is higher in patients with active LN [（ 175. 7 ± 25. 67） × 10^（- 15）gL] compared to patients with inactive LN [（ 132. 6 ± 19. 54） × 10^（- 15）gL] and controls [（ 114. 6 ± 19. 70） × 10^（- 15）gL]（ P 〈0. 001）. IL-17 and IL-23 decreased significantly in patients with active LN after 6 months therapy（ P 〈0. 01）. The baseline level of IL-23 was significantly different between different groups as well as the response to the immunosuppressive treatment in patients with active LN. Baseline level of IL-23 in complete response group was lower than in partial response group（ P 〈0. 01） or non-response group（ P = 0. 003）. IL-17 was negatively correlated with C3（ r =- 0. 35,P = 0. 002）. IL-17 and IL-23 correlated with systemic lupus erythematosus（ SLE） disease activity index（ P 〈0. 05）. The correlation between IL-17 and pathological activ

关 键 词：狼疮肾炎 白细胞介素17 白细胞介素23 

分 类 号：R593.241[医药卫生—内科学]