原发性IgA肾病外周血IL-17及TGF-β1的表达及意义

Serum Levels of IL-17 and TGF-β1 and Their Clinical Value in Patients with Primary Immunoglobulin A Nephropathy

目的:探讨白介素17(interleukin-17,IL-17)和转化生长因子β1(transforming growth factorβ1,TGF-β1)在原发性IgA肾病(immunoglobulin A nephropathy,IgAN)患者外周血的水平及意义。方法:选取诊断明确的原发性IgAN患者40例和非IgAN(non-IgA nephropathy,n-IgAN)患者32例,采用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测外周血IL-17和TGF-β1表达水平,同期检测24 h尿蛋白定量和血清IgA及补体C3浓度,分析肾组织新月体形成情况。结果:与n-IgAN组相比,IgAN组外周血IL-17、TGF-β1水平均较高,24 h尿蛋白定量较低,差异均有统计学意义(P<0.01)。2组患者IL-17/TGF-β1比值、IgA/C3比值及新月体检出率比较差异均无统计学意义。不同程度尿蛋白排泄的IgAN各亚组(24h尿蛋白<0.5 g、0.5～1.0g、1.0～3.5 g和>3.5 g)之间,IL-17、TGF-β1、IL-17/TGF-β1及IgA/C3比值差异亦无统计学意义。Spearman相关分析显示,IL-17、TGF-β1均与新月体形成呈正相关(r=0.484,P=0.000;r=0.498,P=0.000);TGF-β1还与IL-17(r=0.806,P=0.000)、IgA/C3比值(r=0.342,P=0.017)呈正相关,与24 h尿蛋白定量呈负相关(r=-0.317,P=0.011)。结论:原发性IgA肾病患者外周血IL-17和TGF-β1表达上调且显著相关,两者均与新月体形成有关;TGF-β1还与24 h尿蛋白定量、IgA/C3比值相关。血清IL-17、TGF-β1可能成为肾小球损伤新的标志物和预后判断指标。

Objective：To detect the serum levels of interleukin-17（IL-17） and transforming growth factor β1（TGF-β1） in primary immunoglobulin A nephropathy（IgAN）, and to investigate their clinical value. Methods： Forty patients with primary IgAN and 32 patients with non-IgA nephropathy（n IgAN）were enrolled. Enzyme-linked immunosorbent assay（ELISA） was used to detect serum levels of IL-17 and TGF-β1. And 24 h urinary protein,serum IgA and complement C3 were tested. Glomerular crescent formation was also analyzed. Results： Compared with n IgAN group,IgAN group showed higher levels of serum IL-17 and TGF-β1, but less 24 h urinary protein（P〈0.01 ）. There were no significant differences in IL-I 7/TGF-β1 ratio , IgA/ C3 ratio and crescent incidence between the two groups. Subgroups of IgAN divided according to 24 h urinary protein excretion （24 h urinary protein was less than 0.5 g,0.5 to 1.0 g,1.0 to 3.5 g and more than 3.5 g）showed no significant differences in serum levels of IL-17,TGF-β1 ,IL-17/TGF-β1 ratio and IgA/C3 ratio. Serum levels of IL-17 and TGF-β1 were positively corre lated with incidence of crescent（r = 0. 484, P = 0. 000 and r=0. 498, P = 0. 000）. TGF-β1 exhibited positive correlation with IL 17（r= 0. 806,P = 0. 000） ,IgA/C3 ratio（r= 0. 342,P= 0. 017） and negative correlation with 24 h urinary protein（r=- 0. 317, P = 0.011 ）. Conclusions： Serum levels of IL 17 and TGF-β1 were upregulated in IgAN and both were correlated with crescent formation. TGF-β1 was also correlated with 24 h urinary protein and IgA/C3 ratio. IL-17 and TGF-β1 may be valuable markers for glomerular iniury and prognosis.