激素抵抗型肾病综合征患者血清和尿转化生长因子-β1、白细胞介素-18的表达水平检测及其临床意义

Detection and Clinical Significance of TGF-β1,IL-18 Levels in Serum and Urine in Patients with Steroid-Resistant Nephrotic Syndrome

目的探讨激素抵抗型肾病综合征(SRNS)患者血清、尿转化生长因子(TGF)-β1和白细胞介素(IL)-18的表达水平及其临床意义。方法选择2016年1月～2017年12月上海市杨浦区市东医院收治的原发性肾病综合征(PNS)患者120例作为研究对象,其中激素敏感型肾病综合征89例(SSNS组)和SRNS组31例,另选择同期健康体检者50例(对照组)。采用酶联免疫吸附法(ELISA)检测治疗前、治疗后1周、4周(对照组体检当天)血清和尿TGF-β1与IL-18水平,分析尿TGF-β1和IL-18与肾功能指标的相关性。结果治疗前,SSNS组和SRNS组血清、尿TGF-β1,IL-18水平明显高于对照组血清(4.87±0.96,5.41±1.15vs 3.64±0.63)μg/L,(0.58±0.19,0.69±0.22vs 0.28±0.09)μg/L,尿(29.17±4.21,31.48±5.11vs 18.64±3.17)pg/ml,(47.81±14.65,50.12±17.98vs 21.14±9.06)pg/ml,SRNS组血清TGF-β1和IL-18水平明显高于SSNS组(P<0.05)。治疗后1,4周,SSNS组血清、尿TGF-β1和IL-18水平随时间明显下降,明显低于同期SRNS组(P<0.05),治疗后4周与对照组比较,差异无统计学意义(P>0.05)。SRNS组血清、尿TGF-β1,IL-18水平治疗后1,4周分别与治疗前比较,差异均无统计学意义(P>0.05)。尿和血清TGF-β1,IL-18与24h尿蛋白,Scr,BUN水平均呈显著正相关(尿:r=0.459,0.396,0.387,0.418,0.404和0.391,血清:r=0.467,0.405,0.399,0.426,0.416和0.387,均P<0.05)。结论 SRNS患者血清和尿TGF-β1,IL-18水平明显升高,其持续升高对SRNS有一定预测价值。

Objective To explore the expression and clinical significance of TGF-β1 and IL-18 levels in serum and urine in pa tients with steroid resistant nephrotic syndrome （SRNS）. Methods 120 patients with primary nephrotic syndrome（PNS） including 31 cases of SRNS （SRNS group） and 89 cases of steroid sensitive nephrotic syndrome （SSNS） （SSNS group） who were hospitalized were selected as research group,and 50 healthy control were selected as control group from January 2016 to December 2017. The serum and urine levels of TGF-β1 and IL-18 in the patients before treatment and 1,4 weeks after treatment and control group at the test day were detected by ELISA. The correlation of urine TGF-β1 and IL-18 with renal function indexes were also analyzed. Results Before treatment, the serum and urine levels of TGF-β1 and IL-18 were signifi candy higher than those in control group serum （4.87±0.96,5.41±1.15 vs 3.64±0.63）μg/L,（0.58±0.19,0.69±0.22 vs 0. 28±0. 09）μg/L,urine （29.17±4.21,31.48±5.11 vs 18.64±3.17）pg/ml, （47.81±14.65,50.12±17.98 vs 21.14±9.06）pg/ml. Furthermore, SRNS group had obviously higher serum levels of TGF-β1 and IL-18 than SSNS group （P〈 0.05）. After treatment for 1,4 weeks, the serum and urine levels of TGF-β1 and IL-18 in SSNS group were significantly de creased with time, and significantly lower than those in SRNS group of the same period （P〈0.05）, the levels at 4 weeks af ter treatment were no significant difference compared with control group （P〈0.05）. There were no significant difference on the serum and urine levels of TGF-β1 and IL-18 in SRNS group at 1,4 weeks after treatment compared with before treat ment, respectively （Pβ0.05）. Urine and serum levels of TGF-β1, IL-18 was significantly positive correlated with 24 h urine protein,Scr and BUN level （urine： r=0. 459,0. 396,0. 387,0. 418,0. 404 and 0. 391,serum： r=0. 467,0. 405,0. 399,0. 426, 0. 416 and 0. 387,all P〈0.05）. Conclusion The levels of TGF-β1, IL-18 in serum and urine in patients with SRNS were overexpressed,and the increasing levels have predictive value on SRNS.