血清瘦素和白细胞介素-6及肿瘤坏死因子-α水平与狼疮性肾炎的相关性研究

Levels of leptin、inteleukin6、tumor necrosis factorα in serum of patients with lupus nephritis

目的 探讨血清瘦素和白细胞介素-6（interleukin-6,IL-6）及肿瘤坏死因子-α（TNF-α）在狼疮性肾炎（LN）患者中的变化及临床价值.方法 选择LN患者83例,根据系统性红斑狼疮疾病活动指数（SLE disease activity index,SLEDAI）对LN患者进行评分,并将其分为LN稳定期组（33例）和活动期组（50例）.选择与LN患者性别、年龄和体重指数（Body Mass Index,BMI）均相匹配的健康体检者40例为对照组.采用放射免疫法测定血清瘦素水平,采用酶联免疫吸附法（Enzyme-linked immunosorbent Assay,ELISA）检测IL-6、TNF-α的水平,比较各组间的差异,分析血清瘦素和IL-6及TNF-α水平与一些临床指标间的关系.结果 LN患者血清瘦素和IL-6及TNF-α水平均高于健康对照组（P＜0.01）;LN活动期组血清瘦素和IL-6及TNF-α水平均高于LN稳定期组与健康对照组（P＜0.01）;LN稳定期组血清瘦素和IL-6及TNF-α水平与健康对照组比较,差异无统计学意义（P＞0.05）.LN患者血清瘦素和IL-6及TNF-α水平与抗核抗体、ds-DNA抗体、抗核小体抗体、抗C1q抗体、SLEDAI评分、血沉、C反应蛋白、24h尿蛋白定量、血肌酐呈正相关（P＜0.05或P＜0.01）;与补体C3、补体C4、内生肌酐清除率呈负相关（P ＜0.05或P＜0.01）;血清瘦素与IL-6及TNF-α水平呈正相关（P＜0.05,P＜0.01）.结论 瘦素和IL-6及TNF-α可能协同参与了LN的发病过程.动态检测LN患者血清瘦素和IL-6及TNF-α水平,可能有助于监测狼疮活动、评判病情轻重、选择治疗方案、观测疗效及判断预后。

Objectives To investigate serum levels of leptin,interleukin-6 （IL-6）,tumor necrosis factor-α （TNF-α） and its clinical value in lupus nephritis （LN） patients.Methods Eight-three patients with LN were divided into 2 groups（33 cases in inactive group and 50 cases in active group） according to SLEDAI （SLE disease activity index）.To select 40 healthy people of matched sex,age and BMI（Body Mass Index） with LN Patients as The control group.Leptin levels were measured by radio immunoassay.IL-6,TNF-αlevels were measured by sandwich ELISA.The difference between groups and correlation of these parameters with clinical indicators were analysed.Results Leptin,IL-6,and TNF-αleves were significantly higher in the patients with LN than in the healthy controls （P 〈 0.01）;Lepin,IL-6,TNF-α in Active group in the patiens with LN were significantly higher than in the healthy controls and in the inactive group（P 〈 0.01）;There were no statistically differences to compare leptin,IL-6,TNF α levels with the health controls（P 〉0.05）;The serum levels of lepin,IL-6,TNF-αare？ positively correlated with ANA,anti-dsDNA,anti-nucleosome and anti-C1 q antibodies,SLEDAI score,ESR,C-reactive protein,24 hour urine protein,Serum creatinine （P 〈 0.05 or P 〈 0.01） and negatively correlated with complement C3,complement C4 and creatinine clearance（P 〈0.05 orP 〈0.01）.The leptin are positively correlated IL-6 and TNF-α.Conclusions Leptin,IL-6 and TNF-α synergistically take part in the progress of LN.The dynamic observation of the levels of serum leptin,IL-6 and TNF-α contributes to monitor LN activity,evaluate the severity of desease,select treatment scheme,judge treatment affectiveness and prognosis.