尿血红素加氧酶与系统性红斑狼疮患者肾损害及其活动性的相关关系  

Association of urinary heme oxygenase with renal damage and activity in patients with systemic lupus erythematosus

作　　者：翟红福 倪利华 吴小燕[1,2] Zhai Hong-fu;Ni Li-hua;Wu Xiao-yan(Department of Nephrology,Zhongnan Hospital of Wuhan University,Wuhan 430070,China;Department of Family Medicine,Zhongnan Hospital of Wuhan University,Wuhan 430070,China)

机构地区：[1]武汉大学中南医院肾内科,武汉430070 [2]武汉大学中南医院全科医学科,武汉430070

出　　处：《临床肾脏病杂志》2024年第8期629-635,共7页Journal Of Clinical Nephrology

摘　　要：目的探讨尿血红素加氧酶1(heme oxygenase 1,HO-1)水平与系统性红斑狼疮(systemic lupus erythematosus,SLE)患者肾损害及狼疮活动性之间的相关关系,确定尿HO-1狼疮肾炎(lupus nephritis,LN)诊断及其活动度判断中的价值。方法收集于2023年1月至2023年7月就诊于武汉大学中南医院的确诊为SLE的患者,根据有或没有肾脏受累分为LN组及非LN组。通过酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)测定尿液中HO-1水平,同时通过SLE疾病活动度评分(systemic lupus erythematosus disease activity index,SLEDAI)评估疾病活动水平。比较LN组与非LN组患者的尿HO-1水平及其它临床资料,使用Logistic回归分析SLE患者发生LN的危险因素,并绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)判断尿HO-1对于SLE患者肾损害的诊断效能。结果共纳入65例确诊为SLE的患者,其中40例有肾脏受累,25例无肾脏受累。有肾脏损害者尿HO-1水平明显高于无肾脏损害的SLE患者[(740.42±86.98)ng/L比(679.03±61.33)ng/L,P=0.003],且尿HO-1水平与SLEDAI、血肌酐、尿蛋白呈正相关,与肾小球滤过率、内生肌酐清除率呈负相关。尿HO-1与IgG、低补体血症、血尿是LN的独立危险因素,其预测LN的ROC曲线下面积为0.853,95%CI:0.753~0.953;而HO-1单独诊断SLE患者肾损害的ROC曲线下面积为0.710,当HO-1为721 ng/L时,约登指数达到最佳临界值。结论有肾损害的SLE患者尿液中HO-1水平明显升高,且与狼疮活动性有关。HO-1对于判断SLE患者肾损害及疾病活动有一定临床价值。Objective To explore the association of urinary heme oxygenase 1(HO-1)with renal damage and lupus activity in patients with systemic lupus erythematosus(SLE)and determine the value of urinary HO-1 in the diagnosis and activity estimation of lupus nephritis(LN).Methods A total of 65 patients with confirmed SLE were assigned into two groups of LN(n=40)and non-LN(n=25)according to whether or not there was renal damage.Urinary HO-1 was measured by enzyme-linked immunosorbent assay(ELISA)while the level of disease activity assessed by SLE Disease Activity Score(SLEDAI).Urinary HO-1 level and other clinical data were compared between two groups.Logistic regression was utilized for examining the risk factors of LN and receiver operating characteristic(ROC)curve plotted for determining the diagnostic efficacy of urinary HO-1 for renal damage.Results Urinary HO-1 level in patients with renal damage was significantly higher than that without renal damage[(740.42 ± 86.98)ng/L vs (679.03 ± 61.33)ng/L, P = 0.003]. Urinary HO-1 level was correlated positivelywith SLEDAI, serum creatinine and urinary protein while negatively with glomerular filtration rate andcreatinine clearance rate. Urinary HO-1, IgG, hypocomplementemia and hematuria were independent riskfactors for LN (AUC = 0.853,95%CI: 0.753-0.953). Area under the ROC curve for HO-1 alone was 0.710.When HO-1 was 721 ng/L, Youden index reached the optimal cut-off value. Conclusion Urine HO-1level is significantly elevated in SLE patients with renal damage and it is associated with lupus activity.And HO-1 has clinical value in determining renal damage and disease activity in SLE patients.

关 键 词：系统性红斑狼疮 狼疮肾炎 狼疮肾损害 尿血红素加氧酶 狼疮活动 

分 类 号：R593.241[医药卫生—内科学] R692[医药卫生—临床医学]