狼疮性肾炎患者尿单核-巨噬细胞趋化蛋白-1和转化生长因子-β_1检测的临床意义

Detection and clinical significance of monocyte chemoattractant protein-1 and transforming growth factor-beta in urine of lupus nephritis

目的探讨狼疮性肾炎(LN)患者尿单核-巨噬细胞趋化蛋白-1(MCP-1)和转化生长因子-β_1 (TGF-β_1)检测的临床意义。方法对57例经肾活检证实为LN患者的尿MCP-1和TGF-β_1水平进行检测,24名健康者为正常对照组。结果与正常对照组比较,57例LN患者尿MCP-1和TGF-β_1增高(P<0.05),LN-Ⅳ型尿MCP-1和TGF-β_1明显高于LN-Ⅱ和LN-Ⅲ型(P<0.05),LN-Ⅴ和LN-Ⅵ型尿MCP-1无改变(P>0.05),而尿TGF-β_1增高(P<0.05);在活动期和非活动期LN患者尿MCP-1和TGF-β_1水平高于正常对照组(P<0.01),活动期尿MCP-1和TGF-β_1水平明显高于非活动期(P<0.05);LN-Ⅳ型尿MCP-1和TGF-β_1水平与24 h尿蛋白定量、血肌酐呈明显正相关(r=0.621、0.711,P<0.05;r=0.568、0.631,P<0.05)。LN-Ⅱ、LN-Ⅲ、LN-Ⅴ、LN-Ⅵ型尿MCP-1和TGF-β_1与24 h尿蛋白定量和血肌酐无明显相关性(P>0.05);尿MCP-1水平与肾脏活动指数成正相关(r=0.681,P<0.05),尿TGF-β_1与慢性化指数密切相关(r=0.605,P<0.05)。结论尿MCP-1和TGF-β_1水平可作为反映LN病情变化,判断病理类型的重要指标。

Objective To investigate clinical significance of urinary monocyte chemoattractant protein-1 （MCP-1） and transforming growth factor-beta （TGF-β1） in patients with lupus nephritis （LN）. Methods 57 patients with LN were selected in this study, and 24 healthy people as control. All the level of urinary MCP-1 and TGF-β1 were detected by ELISA. Results In 57 patients with LN, the levels of urinary MCP-1 and TGF-β1 were significantly increased in class LN-Ⅱ, LN-Ⅲ and LN-Ⅳ compared with those of the control（P 〈0.05）, and they were more higher in LN-Ⅳ than those in LN-Ⅱ and LN-Ⅲ （P 〈0.05）. There was no difference between the levels of urinary MCP-1 in LN-Ⅴ and LN-Ⅵ and those of the control, but the levels of urinary TGF-β1 in LN-Ⅴ and LN-Ⅵ were significantly increased compared with the controls （P 〈0.05）.The levels of urinary MCP-1 and TGF-β1 were significantly increased in active phase compared with remission phase, but still higher in remission phase than those in control （P 〈0.05）. The levels of urinary MCP-1 and TGF-β1 in class LN-Ⅳ were positively correlated with 24 h urinary protein quantitative determination （r=0.621, P 〈0.05; r=0.711, P 〈0.05）; and were positively correlated with serum creatinine（r=0.568, P 〈0.05; r=0.631, P 〈0.05）. No correlation was found in other classification. MCP-1 in urine was positively correlated with SLEDAI （r=0.681, P 〈0.05）; and TGF-β1 in urine was positively correlated with chronic index （r=0.605, P 〈0.05）. Conclusion The levels of urinary MCP-1 and TGF-β1 can be used as an important predictor to assess disease activity, to estimate pathological type change in LN.