成人过敏性紫癜肾炎病理分级与血清TGF-β1、MCP-1、IL-17水平的关系

The relationships between pathological grade of Henoch-Schonlein purpura nephritis and levels of serum TGF-β1,MCP-1 and IL-17 in adults

目的研究成人过敏性紫癜肾炎(HSPN)病理分级与血清转化生长因子-β1(TGF-β1)、单核细胞趋化蛋白-1(MCP-1)、IL-17水平的关系。方法选择2015年6月至2017年12月在本院接受治疗的HSPN患者98例为研究组,另选择Ig A肾炎患者65例为Ig A肾炎组,同期来本院体检的健康者60例为对照组,检测三组血清中TGF-β1、MCP-1、IL-17水平,分析HSPN患者临床资料,对影响患者病情的危险因素进行Cox回归分析。结果研究组血清TGF-β1、MCP-1、IL-17水平显著高于Ig A肾炎组、对照组(P <0. 05);Ig A肾炎组血清TGF-β1、MCP-1、IL-17水平显著高于对照组(P <0. 05)。不同分型HSPN患者间年龄、性别、血红蛋白、血白蛋白、尿蛋白量、肾外表型比较差异均无统计学意义(P> 0. 05);Ⅲ型血小板低于Ⅱ型(P <0. 05);Ⅳ型、Ⅴ、Ⅵ型CRP水平高于Ⅱ型(P <0. 05);Ⅲ、Ⅳ、Ⅴ、Ⅵ型患者的肾小球硬化程度高于Ⅱ型,且Ⅴ、Ⅵ型患者肾小球硬化程度高于Ⅲ型(P <0. 05);Ⅲ、Ⅳ、Ⅴ、Ⅵ型患者的新月体形成高于Ⅱ型,且Ⅳ、Ⅴ、Ⅵ型患者新月体形成高于Ⅲ型(P <0. 05)。Ⅱ型患者血清TGF-β1、MCP-1、IL-17水平最低,Ⅴ、Ⅵ型患者最高;且Ⅲ、Ⅳ、Ⅴ、Ⅵ型中TGF-β1、MCP-1、IL-17水平均显著高于Ⅱ型(P <0. 05),Ⅳ、Ⅴ、Ⅵ型中TGF-β1水平均显著高于Ⅲ型(P <0. 05);Ⅴ、Ⅵ型血清IL-17水平显著高于Ⅲ型(P <0. 05)。Cox回归分析结果提示MCP-1、IL-17是影响HSPN患者病理分级的危险因素。结论成人过敏性紫癜肾炎病理分级越高,血清MCP-1、IL-17水平越高,MCP-1、IL-17均是影响患者病理分级的危险因素。

Objective To study the relationships between pathological grade of Henoch-Schonlein purpura nephritis( HSPN) and levels of serum transforming growth factor-beta 1( TGF-β1),monocyte chemoattractant protein 1( MCP-1),interleukin( IL)-17 and prognosis in adults. Methods 98 HSPN patients treated in our hospital from June 2015 to December 2017 were selected as the study group,65 IgA nephritis patients were selected as the IgA nephritis group,and 60 healthy people who came to our hospital for physical examination during the same period were selected as the control group. The levels of TGF-β1,MCP-1 and IL-17 in serum of the three groups were detected,and the Cox regression analysis was used to analyze the risk factors affecting the patient’s condition. Results The levels of serum TGF-β1,MCP-1 and IL-17 in the study group were significantly higher than those in IgA nephritis group and control group( P <0. 05). The levels of serum TGF-β1,MCP-1 and IL-17 in IgA nephritis group were significantly higher than those in control group( P < 0. 05). There was no significant difference in age,sex,hemoglobin,albumin,urinary protein and renal phenotype among groups( P < 0. 05). Platelets of type Ⅲ were significantly lower than those of type Ⅱ( P < 0. 05);C-reactive protein( CRP) level of type Ⅳ,Ⅴ and Ⅵ was significantly higher than that of type Ⅱ( P < 0. 05). The degree of glomerulosclerosis in patients with type Ⅲ,Ⅳ,Ⅴand Ⅵ was significantly higher than that in patients with type Ⅱ,and the degree of glomerulosclerosis in patients with type Ⅴ and Ⅵ was also significantly higher than that in patients with type Ⅲ( P < 0. 05).The formation of crescents in patients with type Ⅲ,Ⅳ,Ⅴ and Ⅵ was significantly higher than that in patients with type Ⅱ,and the formation of crescents in patients with type Ⅳ,Ⅴ and Ⅵ was also significantly higher than that in patients with type Ⅲ( P < 0. 05). The levels of serum TGF-β1,MCP-1 and IL-17 were the lowest in type Ⅱ patients and the highest in type Ⅴ and Ⅵ patients. The levels of TGF-β1,MCP-1 and IL-17 in type Ⅲ,Ⅳ,Ⅴ and Ⅵ were significantly higher than those in type Ⅱ( P < 0. 05),and the level of TGF-β1 in type Ⅳ,Ⅴ and Ⅵ was significantly higher than that in type Ⅲ( P < 0. 05);Serum IL-17 level of type Ⅴ and Ⅵ was significantly higher than that of type Ⅲ( P < 0. 05). Cox regression analysis showed that TGF-β1 and IL-17 were risk factors for pathological grading. Conclusions The higher the pathological grade of Henoch-Schonlein purpura nephritis in adults,the higher the levels of serum TGF-β1 and IL-17. TGF-β1 and IL-17 are the risk factors affecting the pathological grade of Henoch-Schonlein purpura nephritis.