抗血管紧张素Ⅱ-1型受体抗体是狼疮性肾炎活动和系统损伤的新标记  

Anti-angiotensinⅡtype 1 receptor antibody:A marker of lupus activity and organ injury in patients with lupus nephritis

作　　者：夏文 邓佳仪 庄璐璐 刘洋 谌达程 徐峰 刘正钊 许书添 左科 张丽华 胡伟新 XIA Wen;DENG Jiayi;ZHUANG Lulu;LIU Yang;CHEN Dacheng;XU Feng;LIU Zhengzhao;XU Shutian;ZUO Ke;ZHANG Lihua;HU Weixin(National Clinical Research Center of Kideny Diseases,Jinling Hospital,Nanjing Medical University,Nanjing 210016,China)

机构地区：[1]南京医科大学金陵临床医学院(东部战区总医院)、国家肾脏疾病临床医学研究中心全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2023年第2期101-106,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金(82170741);江苏省重大疾病生物资源样本库运行经费(BM2015004-1)。

摘　　要：目的:探究抗血管紧张素Ⅱ-1型受体抗体(AT1R-AA)与狼疮性肾炎(LN)患者临床和病理特征的相关性。方法:98例经肾活检确认活动性LN患者,ELISA法检测血清AT1R-AA(>17 U/mL定义为阳性)。狼疮活动所致3个及以上其他系统损伤定义为多系统受累。根据AT1R-AA与抗dsDNA或抗-C1q抗体是否同时阳性分为抗体单阳性和双阳性两组。选择18例性别年龄与LN患者匹配的健康人作为正常对照,14例患者免疫抑制治疗获得缓解时重复检测AT1R-AA。结果:98例LN患者中位SLE疾病活动度评分(SLE-DAI)13(10,16)分,近一半存在多器官系统受累,中位血清AT1R-AA水平显著高于正常对照(17.6 U/mL vs 7.93 U/mL,P<0.001),51%患者血清AT1R-AA阳性,各病理类型间AT1R水平和阳性率无差异。相关性分析发现AT1R-AA水平与SLE-DAI呈正相关(r=0.490,P<0.001),与C3(r=-0.279,P=0.005)和C4(r=-0.270,P=0.007)水平呈负相关。与AT1R-AA阴性患者相比,AT1R-AA阳性患者的SLE-DAI(P<0.001)、系统受累数(P<0.001)和多系统损伤比例(P<0.001)均显著增加,血清C3水平(P=0.021)和慢性化指数(CI)(P=0.049)显著降低,肾脏损伤指标两组间无统计学差异。与抗体单阳组比较,抗体双阳组的SLE-DAI(P<0.001)、多系统受累(P=0.037)和急性肾损伤比例(P=0.016)显著增高,而血清C3(P=0.021)和C4(P=0.022)水平显著降低。治疗后获得肾脏缓解的14例患者血清AT1R-AA水平(22.9 U/mL vs 12.4 U/mL,P=0.001)和阳性率(78.6%vs 21.4%,P=0.008)均显著下降。结论:AT1R-AA是LN患者活动的血清学新标记,其水平与SLE-DAI及系统受累相关;AT1R-AA与抗dsDNA或抗C1q抗体共阳性患者的狼疮活动性、系统受累及肾损伤程度显著增加。Objective:To explore the correlation between anti-angiotensinⅡType 1 receptor antibody(AT1R-AA)and clinicopathological characteristics of patients with lupus nephritis(LN).Methodology:98 patients with active LN confirmed by renal biopsy were evaluated for lupus activity using SLE-DAI.Renal tissue activity index(AI)and chronicity index(CI)were semi-quantitatively scored.Serum AT1R-AA was detected by ELISA(>17 U/mL defined as positive).Involvement of 3 or more other systems due to lupus activity was defined as multi-system involvement.According to whether AT1R-AA and anti-dsDNA or anti-C1q antibodies were simultaneously positive,they were divided into two groups:single positive and double positive antibodies.18 healthy individuals matched for gender and age with LN patients were selected as normal controls.AT1R-AA was retested in 14 patients who achieved remission after immunosuppressive therapy.Results:The median SLE-DAI score of 98 LN patients was 13(10,16),nearly half had multi-system involvement,and the median serum AT1R-AA level in LN patients was significantly higher than that in the normal control group(17.6 U/mL vs 7.93 U/mL,P<0.001).51%of patients had positive serum AT1RAA,and there were no difference in AT1R level and positivity rate among different pathological types.Correlation analysis showed that AT1R-AA level was positively correlated with SLE-DAI(r=0.490,P<0.001)and negatively correlated with C3(r=-0.279,P=0.005)and C4(r=-0.270,P=0.007)levels.Compared with AT1R-AA negative patients,AT1R-AA positive patients had significantly higher SLE-DAI scores(P<0.001),number of organ systems involved(P<0.001),and proportion of multiorgan system damage(P<0.001),significantly decreased serum C3 levels(P=0.021)and CI scores(P=0.049),and no significant difference in renal injury indicators between the two groups.Compared with the single antibody positive group,the double antibody positive group had significantly higher SLE-DAI scores(P<0.001),multiorgan system involvement(P=0.037),and acute kidney injury

关 键 词：抗血管紧张素Ⅱ-1型受体抗体 狼疮性肾炎 狼疮活动性 

分 类 号：R593.242[医药卫生—内科学]