彭莉, 王莉, 刘维佳, 潘春勤, 刘杰. 血清白细胞介素-17A、白细胞介素-23预测IgA血管炎继发性肾炎发生和进展的临床价值分析[J]. 临床肾脏病杂志, 2022, 22(10): 793-799. DOI: 10.3969/j.issn.1671-2390.2022.10.001
    引用本文: 彭莉, 王莉, 刘维佳, 潘春勤, 刘杰. 血清白细胞介素-17A、白细胞介素-23预测IgA血管炎继发性肾炎发生和进展的临床价值分析[J]. 临床肾脏病杂志, 2022, 22(10): 793-799. DOI: 10.3969/j.issn.1671-2390.2022.10.001
    Peng Li, Wang Li, Liu Wei-jia, Pan Chun-qin, Liu Jie. Clinical values of serum interleukin-17A and interleukin-23 in predicting the occurrence and progression of IgA vasculitis nephritis[J]. Journal of Clinical Nephrology, 2022, 22(10): 793-799. DOI: 10.3969/j.issn.1671-2390.2022.10.001
    Citation: Peng Li, Wang Li, Liu Wei-jia, Pan Chun-qin, Liu Jie. Clinical values of serum interleukin-17A and interleukin-23 in predicting the occurrence and progression of IgA vasculitis nephritis[J]. Journal of Clinical Nephrology, 2022, 22(10): 793-799. DOI: 10.3969/j.issn.1671-2390.2022.10.001

    血清白细胞介素-17A、白细胞介素-23预测IgA血管炎继发性肾炎发生和进展的临床价值分析

    Clinical values of serum interleukin-17A and interleukin-23 in predicting the occurrence and progression of IgA vasculitis nephritis

    • 摘要: 目的 分析血清白细胞介素(interleukin,IL) 17A、IL-23预测免疫球蛋白A血管炎(immunoglobulin A vasculitis,IgAV)继发性肾炎发生和进展的临床价值。方法 选取2018年1月至2021年10月于长江大学附属仙桃市第一人民医院住院的IgAV患者71例作为研究对象,另选取50名年龄和性别匹配的健康对照者纳入研究。根据是否存在肾脏受累,将IgAV患者分为IgAV肾炎组(n=28)和IgAV非肾炎组(n=43)。采用Luminex xMAP液态芯片技术检测血清细胞因子谱。绘制受试者工作特征(receiveroperating characteristic,ROC)曲线以确定血清IL-17A、IL-23对IgAV和IgAV肾炎的诊断价值。结果 IgAV患者血清IL-17A、IL-23水平均高于正常对照组,且IgAV肾炎组患者血清IL-17A、IL-23水平亦高于IgAV非肾炎组患者(P<0.05)。经ROC曲线分析,血清IL-17A用于IgAV或IgAV肾炎诊断的曲线下面积(area under the curve,AUC)分别为0.804 (95% CI: 0.725~0.882)、0.778 (95%CI: 0.670~0.886),均大于0.7。IgAV患者血清IL-17A或IL-23高表达与血尿/蛋白尿患者比例更高有关(P<0.05),且血清IL-17A水平与血肌酐(r=0.443,P<0.001)、血尿素氮(r=0.259,P=0.029)、胱抑素C(r=0.391,P<0.001)、临床评分(r=0.734,P<0.001)呈正相关关系,与估算肾小球滤过率(r=-0.474,P<0.001)呈负相关关系。血清IL-23水平与胱抑素C (r=0.400,P<0.001)、临床评分(r=0.243,P=0.041)呈正相关关系,与估算肾小球滤过率(r=-0.373,P<0.001)呈负相关关系。此外,IgAV肾炎患者血清IL-17A、IL-23水平与肾脏疾病国际研究组分级呈正相关关系(r=0.718,0.648,P<0.001)。结论 IL-17A和IL-23可作为监测IgAV继发性肾炎进展的生化指标。

       

      Abstract: Objective To explore the clinical values of serum interleukin 17A(IL-17A)and IL- 23 in predicting the occurrence and progression of immunoglobulin A vasculitis(IgAV)complicated with nephritis. Methods From January 2018 to October 2021,71 IgAV patients were selected along with 50 age/ gender-matched healthy volunteers as normal control group. IgAV patients were further divided into nephritis (n=28)and non-nephritis(n=43)subgroups based upon the presence or absence of renal involvement. Luminex xMAP liquid chip technology was utilized for detecting the serum levels of cytokines. Receiver operating characteristic(ROC)curves were plotted for determining the diagnostic value of serum IL-17A/ IL-23 for IgAV and IgAV-nephritis. Results The levels of IL-17A and IL-23 were higher in IgAV group group than those in IgAV-non-nephritis group(P<0.05). The area under the ROC curve(AUC)of serum IL-17A for IgAV or IgAV-nephritis was 0.804(95% CI:0.725~0.882)and 0.778(95% CI:0.670~ 0.886). Both were above 0.7. IgAV patients with an elevation of IL-17A or IL-23 had the higher proportion of patients with hematuria/proteinuria(P<0.05);while serum IL-17A levels were correlated positively with serum creatinine(Scr)(r=0.443,P<0.001),blood urea nitrogen(BUN) (r=0.259,P=0.029),cystatin C(CYSC)(r=0.391,P<0.001)and clinical scores(r=0.734,P<0.001)and yet negatively with estimated glomerular filtration rate(eGFR)(r=-0.474,P<0.001). Also serum IL-23 level was correlated positively with serum CYSC(r=0.400,P<0.001)and clinical scores(r=0.243,P=0.041)and negatively with eGFR (r=-0.373,P<0.001). Furthermore,the serum levels of IL-17A and IL-23 were positively correlated with ISKD class in IgAV-nephritis group(r=0.718,0.648,P<0.001). Conclusion IL-17A and IL-23 may be employed as biochemical markers for monitoring the progression of secondary IgAV nephritis.

       

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