IgA肾病患者血清Rho相关卷曲螺旋形成蛋白激酶2、视黄醇结合蛋白4表达水平及在评估病情和预测预后中的价值研究  

Serum expression levels of rho-associated coiled-coil containing protein kinase 2 and retinol-binding protein 4 in patients with IgA nephropathy and their values in evaluating disease condition and predicting prognosis

作　　者：刘永 杨小丹 赵杰 徐艳松 杨宁 张波 Liu Yong;Yang Xiao-dan;Zhao Jie;Xu Yan-song;Yang Ning;Zhang Bo(Department of Nephrology,No.302 Hospital of China Guihang Group,Anshun 561000,China;Department of Laboratory Medicine,No.302 Hospital of China Guihang Group,Anshun 561000,China)

机构地区：[1]中国贵航集团302医院肾内科,安顺561000 [2]中国贵航集团302医院检验科,安顺561000

出　　处：《临床肾脏病杂志》2023年第9期732-738,共7页Journal Of Clinical Nephrology

基　　金：安顺市2022年科技计划项目[安市科社﹝2022﹞29号]。

摘　　要：目的检测IgA肾病(immunoglobulin A nephropathy,IgAN)患者血清Rho相关卷曲螺旋形成蛋白激酶2(rho associated coiled coil containing protein kinase 2,ROCK2)、视黄醇结合蛋白4(retinol-binding protein 4,RBP4)表达水平,分析二者在评估患者病情及预测预后中的价值。方法选取2016年6月至2019年6月98例中国贵航集团302医院已确诊收治的IgAN患者为IgAN组,其中轻度IgAN 36例、中度IgAN 32例、重度IgAN 30例;同期选择在中国贵航集团302医院体检的健康者100名为对照组。酶联免疫吸附法检测血清中ROCK2、RBP4水平;采用Kaplan-Meier生存曲线分析ROCK2、RBP4表达水平与IgAN患者预后的关系;Pearson相关性分析ROCK2与RBP4表达相关性;受试者工作特征曲线(receiver operating characteristic curve,ROC)分析ROCK2、RBP4对IgAN的诊断价值;比例风险回归模型法分析IgAN患者预后的影响因素。结果IgAN组血清中ROCK2、RBP4表达水平分别为(24.25±5.31)μg/L、(59.70±9.43)μg/L,显著高于对照组的(15.57±4.16)μg/L、(32.14±7.82)μg/L,差异具有统计学意义(t=12.818、22.404,均P<0.001);轻度、中度、重度IgAN患者血清中ROCK2水平分别为(18.69±4.36)μg/L、(23.75±5.31)μg/L、(31.46±5.62)μg/L,RBP4表达水平分别为(45.37±7.86)μg/L、(62.48±8.12)μg/L、(73.94±8.65)μg/L。随着病情的加重,IgAN患者血清ROCK2、RBP4表达水平逐渐升高,差异具有统计学意义(F=51.854、102.234,均P<0.05);IgAN患者血清中ROCK2、RBP4表达水平与Lee氏分级、IgA/C3比值、病情程度有关(P<0.05);ROCK2、RBP4高表达组患者预后生存率分别为60.00%、74.19%,均显著低于低表达组的89.71%、91.67%,差异具有统计学意义(log rankχ^(2)=4.674,P=0.031);ROC曲线结果显示,血清ROCK2诊断IgAN的曲线下面积(area under curve,AUC)为0.889,敏感度为80.61%,特异性为80.00%,截断值为18.79μg/L;RBP4诊断IgAN的AUC为0.986,敏感度为96.94%,特异性为95.00%,截断值为41.31μg/L;二者联合检测的AUC为0.997,敏感Objective To detect the expression levels of rho-associated coiled-coil containing protein kinase 2(ROCK2)and retinol-binding protein 4(RBP4)and examine the value of ROCK2/RBP4 in evaluating disease condition and predicting prognosis in patients with immunoglobulin A nephropathy(IgAN).Methods From June 2016 to June 2019,98 IgAN patients were selected as IgAN group,including mild IgAN(n=36),moderate IgAN(n=32)and severe IgAN(n=30).And 100 healthy subjects receiving physical examination during the same period were designated as control group.Serum levels of ROCK2 and RBP4 were detected by enzyme-linked immunosorbent assay(ELISA).Kaplan-Meier survival curve was plotted for examining the relationship between the expression level of ROCK2/RBP4 and prognosis;Pearson's method was employed for analyzing the correlation between ROCK2 and RBP4 ex-pressions;Receiver operating characteristic curve(ROC)for examining the diagnostic value of ROCK2/RBP4 for IgAN;COX method for analyzing the prognostic factors.Results The serum expression levels of ROCK2 and RBP4 were significantly higher in IgAN group than those in control group[(24.25±5.31)μg/L,(59.70±9.43)μg/L vs(15.57±4.16)μg/L,(32.14±7.82)μg/L)].The difference was statistically significant(t=12.818,22.404,all P<0.001).The serum expression levels of ROCK2 and RBP4 were(18.69±4.36)μg/L vs(23.75±5.31)μg/L,(31.46±5.62)μg/L vs(45.37±7.86)μg/L and(62.48±8.12)μg/L vs(73.94±8.65)μg/L in mild/moderate/severe IgAN patients.With the worsening of disease,the expression levels of serum ROCK2 and RBP4 were up-regulated and the difference was statis-tically significant(F=51.854,102.234,all P<0.05).The serum expression levels of ROCK2 and RBP4 were correlated with Lee's grade,IgA/C3 ratio and disease severity(P<0.05);The prognosis survival rates of patients with a high expression of ROCK2/RBP4 were significantly lower than those with a low expression of ROCK2/RBP4(60.00%vs 74.19%,89.71%vs 91.67%)and the difference was statistically significant(Log rank=4.674,P=0.031);ROC

关 键 词：IGA肾病 Rho相关卷曲螺旋形成蛋白激酶2 视黄醇结合蛋白4 

分 类 号：R692.31[医药卫生—泌尿科学]