白介素-18在ANCA相关性小血管炎肾损害患者中的表达及其临床意义  

Expression of interleukin-18 in patients with renal damage induced by ANCA-associated small vasculitis and its clinical significance

作　　者：陈凌舟 彭卫华 许敏敏[5] 彭婷[5] 庄永泽[1] 王丽萍[1] 俞国庆[1] CHEN Lin-zhou;PENG Wei-hua;XU Min-min;PENG Ting;ZHUANG Yong-ze;WANG Li-ping;YU Guo-qing(Department of Nephrology,Fuzhou General Hospital,Clinical Hospital of Second Military Medical University,Fuzhou 350025,China)

机构地区：[1]中国人民解放军南京军区福州总医院肾内科,福州350025 [2]海军军医大学,上海200433 [3]厦门大学,厦门361005 [4]福建医科大学,福州350100 [5]福建中医药大学福总临床医学院,福州350122

出　　处：《临床肾脏病杂志》2018年第10期593-597,共5页Journal Of Clinical Nephrology

基　　金：福建省自然科学基金(No.2014J01430)

摘　　要：目的通过检测抗中性粒细胞胞浆抗体(ANCA)相关性小血管炎(AASV)肾损害患者血清及尿液白介素-18(IL-18)水平,探讨IL-18在AASV肾损害应用中的可能价值。方法比较健康对照组与AASV组、AASV活动组与缓解组间血/尿IL-18水平,分析尿IL-18与传统病情活动性指标如ANCA滴度、血肌酐、C-反应蛋白(CRP)、伯明翰系统性血管炎活动度评分量表(BVAS)评分值等的相关性,绘制尿IL-18评估AASV活动性的ROC曲线,评价IL-18在AASV肾损害中的意义。结果AASV组尿IL-18水平比健康对照组显著升高(P<0.05),AASV活动组尿液与血液IL-18水平均高于缓解组(P<0.05)。治疗随访半年后,病情由活动转为缓解的患者尿IL-18水平较治疗前明显下降(P<0.05)。AASV患者尿IL-18与血清ANCA滴度、BVAS评分值呈正相关(P<0.05),与血肌酐、胱抑素C、CRP、尿微量白蛋白/肌酐比值、尿β_2-微球蛋白等无明显线性相关。AASV活动期患者的血、尿IL-18水平呈正相关(P<0.05)。尿IL-18评估AASV病情活动性的曲线下面积(AUC)为0.816(P<0.05),当检测的截点值为0.130 pg·mL^(-1)·Cr^(-1)时,其敏感度和特异度分别为85.7%和71.4%。结论AASV肾损害患者尿液IL-18水平升高,与疾病活动性相关,在早期预测AASV病情及活动性上有一定价值。Objective To investigate the possible value of interleukin-18（IL-18） in the application of renal damage induced by ANCA associated small vessel vasculitis（AASV）. Methods The levels of serum and urine IL-18 were compared between control group and AASV group,or between AASV active group and remission group. The correlation between urine IL-18 and other clinical indicators such as serum ANCA,creatinine,C-reactive protein（CRP） and BVAS score was analyzed. In combining with ROC curve of urine IL-18 in determining the activity of AASV,the significance of IL-18 in AASV renal damage was evaluated. Results The levels of urinary IL-18 in the AASV group were significantly higher than those in the control group（P〈0. 05）,and the active AASV group had a higher expression of urine and serum IL-18 than the remission group（P〈0. 05）. Six months after treatment,urinary IL-18 levels in patients whose disease was changed from activity to remission were significantly decreased（P〈0. 05）. Urinary IL-18 in AASV patients was positively correlated with serum ANCA and BVAS score（P〈0. 05）,but had no significantly liner correlation with creatinine,serum cystatin C,C-reactive protein,urinary albumin/creatinine ratio and β2-microglobulin. Serum and urine IL-1 8 had a positive correlation in AASV active group（P〈0. 05）. The area under the ROC curve for urine IL-18 in diagnosis of renal damage in AASV w as 0. 8 1 6（P〈0. 0 5）,w hen the cut-off value w as 0. 1 3 0 pg·m L^（-1）·Cr^（-1）,the sensitivity and specificity w ere 8 5. 7 % and 7 1. 4 % respectively. Conclusions The levels of urinary IL-1 8 w ere elevated in patients w ith renal im pairm ent of AASV and correlated w ith disease activity. Urinary IL-1 8 had a certain value in the early prediction of AASV disease activity.

关 键 词：抗中性粒细胞胞浆抗体相关性小血管炎 肾损害 白介素-18 

分 类 号：R692[医药卫生—泌尿科学] R593.2[医药卫生—外科学]