TNF-α水平在抗中性粒细胞胞浆抗体相关性血管炎中的临床意义  

The clinical significance of tumor necrosis factor-α level in anti-neutrophil cytoplasmic antibody-associated vasculitis

作　　者：贺江花 张瑞[2] 谢丽娇[1] 唐莎[1] 王卫黎 刘星[1] 张均[1] 李芙蓉[1] 张静波[1] 

机构地区：[1]第三军医大学新桥医院肾内科,重庆40037 [2]解放军273医院门诊部,库尔勒841000

出　　处：《免疫学杂志》2017年第12期1060-1065,共6页Immunological Journal

基　　金：国家自然科学基金(81571604);第三军医大学新桥医院临床科研基金(2014YLC06);重庆市社会民生科技创新专项(cstc2015shmszx120029)

摘　　要：目的探讨肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)在抗中性粒细胞胞浆抗体相关性血管炎(ANCAassociated vasculitis,AAV)中对肾脏损害程度及预后意义。方法回顾性分析我院2013年7月至2017年7月肾内科经病理活检确诊的41例AAV肾损害患者的临床资料。采用放射免疫法检测血清TNF-α水平。随访肾脏结局利用ROC曲线取TNF-α截点(Cut off值)为14.1 pg/ml,将总体AAV肾损害患者分为高水平TNF-α(≥14.1 pg/ml)及低水平TNF-α(<14.1 pg/ml)组,并比较2组患者生物学特征、肾脏病理特征及预后。结果高水平TNF-α组与低水平组相比,伯明翰血管炎活动性评分(Birmingham vasculitis activity score,BVAS)及肌酐(serum creatinine,Scr)、IL-6、IL-8水平显著升高(P<0.05),肾小球滤过率(estimated glomerular filtration rate,e GFR)、补体3(complement 3,C3)显著下降(P<0.05)。TNF-α与ALB、eGFR、Cys-c、BVAS、ESR、IL-6具有相关性,相关系数r分别为-0.37、-0.49、0.55、0.50、0.32、0.34(P<0.05)。肾脏病理特征显示TNF-α水平升高组肾间质纤维化及肾小管萎缩程度更重(P<0.05)。Kaplan-Meier生存分析显示TNF-α水平升高组肾脏存活率低(Log-Rank=5.230,P=0.022)。结论血清TNF-α水平升高是反映肾脏损伤程度及预后的危险因素。To investigate the clinical significance of the TNF-α level in patients with ANCA-associated vasculitis（AAV）,clinical data of 41 patients with kidney involvement of AAV were collected and analyzed by retrospective observational study.TNF-α were determined by radioimmunoassay method.According to kidney outcome,the patients were divided into two groups of high TNF-α level（≥14.1 pg/ml） and low TNF-α level（14.1 pg/ml） by cut-off value（14.1 pg/ml）.The clinical parameters and histological features were further compared between the two groups.Date showed that patients with high level of TNF-α presented higher level of BVAS,Scr,IL-6,IL-8 and lower level of C3,eGFR,as compared with patients with low level of TNF-α.There were positively correlation between the level of serum TNF-α and Cys-c,BVAS,ESR,IL-6（Pearson correlation coefficient r=0.55,0.50,0.32,0.34,P〈0.05,respectively）,and negatively correlation between the level of serum TNF-α and ALB,e GFR（r=-0.37,-0.49,P〈0.05,respectively）.Meanwhile,histological features showed there were worse interstitial fibrosis and tubular atrophy in high level TNF-α group（P〈0.05）; Kaplan-Meier survival analysis found that there were significant difference of endpoints between patients with low levels of TNF-α group and patients with high level of TNF-α group（log-rank=5.230,P=0.022）.The current study shows that the patients with higher TNF-α level tend to severe renal impairment and poor prognosis.

关 键 词：抗中性粒细胞胞浆抗体 血管炎 TNF-Α 预后 

分 类 号：R593.2[医药卫生—内科学]