尿液蛋白标志物联合检测在狼疮性肾炎中的诊断价值  

Research on the diagnostic value of lupus nephritis through detection three kinds of urine protein

作　　者：王鹏 张吉才 WANG Peng;ZHANG Ji-cai(Department of Laboratory Medicine,Taihe Hospital,Affiliated Hospital of Hubei Medical College,Shiyan 442000,Hubei,China)

机构地区：[1]湖北医药学院附属医院.十堰市太和医院检验科,湖北十堰442000

出　　处：《川北医学院学报》2018年第5期688-692,共5页Journal of North Sichuan Medical College

基　　金：湖北省自然科学基金项目(2014CFB304)

摘　　要：目的:研究血管抑制素,CXC趋化因子配体4(the chemokine C-X-C motif receptor 4,CXC4)和血管细胞黏附分子-1(vascular cell adhesion molecule-1,VCAM-1)三种尿液蛋白标志物在狼疮性肾炎中的诊断价值。方法:收集80例活动性肾型、67例活动性非肾型和80例非活动性系统性红斑狼疮(systemic lupus erythematosus,SLE)患者,以及53例正常健康对照者,分别检测尿液样品中的血管抑制素,CXCL4和VCAM-1水平。进行接受者操作特征分析(receiver operating characteristic curve,ROC)以获得最佳决断值(cut-off值)并计算这些标志物在区分不同组患者中的性能,与抗双链DNA(抗ds DNA)和补体C3相比较。结果:活动性肾型SLE患者的尿血管抑制素,CXCL4和VCAM-1显著高于活动性非肾型SLE患者,非活动性SLE患者和正常对照者。三种尿液蛋白标志物与总SLE疾病活动指数(total SLE disease activity index,SLEDAI)和肾SLEDAI评分以及尿蛋白与肌酐比率显著相关。尿血管抑素在鉴别活动性肾型与活性非肾型SLE[曲线下面积(area under the curve,AUC)0. 87]中比血清抗ds DNA/C3具有更高的特异性和敏感性。另一方面,尿CXCL4(AUC0. 64)和VCAM-1(AUC 0. 73)的表现类似于抗ds DNA/C3。所有三种标志物与抗ds DNA/C3相比都表现出与非活动性SLE相区别的活性。结论:尿液中血管抑制素,CXCL4和VCAM-1是SLE特别是狼疮性肾炎的潜在生物标志物,在预测SLE患者的肾脏病变和预后中具有一定的价值。Objective： To study urinary angiostatin,CXC chemokine ligand 4 （CXCL4） and vascular cell adhesion molecule-1 （VCAM-1） as biomarkers of renal disease in systemic lupus erythematosus （SLE）. Methods： The levels of angiostatin,CXCL4 and VCAM-1 in urine samples were measured in 80 patients with active kidney disease,67 patients with active non-renal disease,80 patients with inactive systemic lupus erythematosus （SLE） and 53 healthy controls.Receiver operating characteristic analysis was performed to obtain the best cutoff values to calculate the performance of these markers in differentiating the different groups of patients as compared to anti-double-stranded DNA （anti-dsDNA） and complement C3.Correlation between these urinary biomarkers and various renal parameters was also tested. Results： Urinary angiostatin,CXCL4 and VCAM-1 （normalized for creatinine） were significantly higher in patients with active renal disease than in patients with active non-renal disease,patients with inactive SLE and controls.These markers correlated significantly with total SLE disease activity index （SLEDAI） and renal SLEDAI scores,and with the urinary protein-to-creatinine ratio.Urine angiostatin exhibited higher specificity and sensitivity in differentiating active renal from active non-renal SLE [area under the curve （AUC） 0.87] than serum anti-dsDNA/C3.Urine CXCL4 （AUC 0.64） and VCAM-1 （AUC 0.73）,on the other hand,performed similarly to anti-dsDNA/C3.All three markers performed comparably to anti-dsDNA/C3 in distinguishing active from inactive SLE. Conclusion： Urinary angiostatin,CXCL4 and VCAM-1 are potential biomarkers for SLE,in particular lupus nephritis,and may play an important role in predicting renal flares and prognosis in SLE patients.

关 键 词：生物标志物 狼疮 肾炎 尿蛋白 

分 类 号：R446[医药卫生—诊断学]