人附睾蛋白4和趋化因子配体9在狼疮性肾炎诊断及预后的应用价值

The application value of human epididymis protein 4 and chemokine ligand 9 in the diagnosis and prognosis of lupus nephritis

目的探讨人附睾蛋白4(HE4)、趋化因子配体9(CXCL9)在狼疮性肾炎(LN)诊断及预后的应用价值。方法选取本院2016年1月~2018年1月收治的82例LN患者作为研究组,另选取80例系统性红斑狼疮(SLE)未合并LN患者作为对照组。检测、对比两组入院时血清HE4、CXCL9水平,应用受试者工作(ROC)曲线分析血清HE4、CXCL9水平诊断价值。研究组均给予常规治疗,共治疗6个月,治疗后随访1年,根据是否发生复合肾脏终点事件分为预后不良者与预后良好者。统计对比两者入院时、治疗6个月后血清HE4、CXCL9水平,采用Logistic回归分析LN预后影响因素,应用ROC曲线分析血清HE4、CXCL9水平对预后不良的预测价值。结果研究组入院时血清HE4、CXCL9水平高于对照组(P<0.05);ROC曲线分析显示,血清HE4、CXCL9联合诊断AUC为0.773,大于HE4(0.670)、CXCL9(0.613),当HE4截断值>160.07 U/mL、CXCL9截断值>218.93 pg/mL时,敏感度为76.83%,特异度为76.25%;预后不良者治疗6个月后血清HE4、CXCL9水平高于预后良好者(P<0.05);Logistic回归分析显示,SLEDAI评分(OR=2.820)、血清HE4(OR=1.283)、CXCL9(OR=2.141)水平是LN预后的重要影响因素(P<0.05);ROC曲线分析显示,治疗6个月后CXCL9预测预后不良AUC为0.670,大于HE4(0.667),当截断值>191.88时,敏感度为60.00%,特异度为76.12%。结论血清HE4、CXCL9在LN中呈高表达状态,联合检测具有良好诊断价值,是预后的重要影响因素,可作为预后不良的预测因子。

Objective To investigate the value of human epididymis protein 4(HE4)and chemo⁃kine ligand 9(CXCL9)in the diagnosis and prognosis of lupus nephritis(LN).Methods 82 patients with LN who were admitted to our hospital were enrolled from January 2016 to January 2018.Eighty patients with systemic lupus erythematosus(SLE)without LN were selected as the control group.Serum HE4 and CXCL9 levels were measured and compared between the two groups.The diagnostic value of serum HE4 and CXCL9 levels was analyzed by using the receiver work(ROC)curve.All the patients in the study group received rou⁃tine treatment for 6 months.After the treatment,they were followed up for 1 year.According to whether the compound renal endpoint occurred,the patients with poor prognosis and prognosis were classified.The serum levels of HE4 and CXCL9 were measured at the time of admission and 6 months after treatment.Logistic re⁃gression analysis was used to analyze the prognostic factors of LN.The ROC curve was used to analyze the pre⁃dictive value of serum HE4 and CXCL9 levels for poor prognosis.Results The levels of serum HE4 and CX⁃CL9 in the study group were higher than those in the control group(P<0.05).The ROC curve analysis showed that the combined AUC of serum HE4 and CXCL9 was 0.773,which was greater than HE4(0.670)and CX⁃CL9(0.613),when the cutoff value of HE4>160.07 U/mL and the cutoff value of CXCL9>218.93 pg/mL,the sensitivity was 76.83%and the specificity was 76.25%;the serum HE4 and CXCL9 levels were higher than those with good prognosis after 6 months of treatment(P<0.05).Logistic regression analysis showed that SLE⁃DAI score(OR=2.820),serum HE4(OR=1.283),and CXCL9(OR=2.141)levels were important factors af⁃fecting the prognosis of LN(P<0.05);the ROC curve analysis showed that CXCL9 predicted a poor prognosis AUC of 0.670 after treatment for 6 months,which was greater than HE4.(0.667),when the cutoff value was>191.88,the sensitivity was 60.00%and the specificity was 76.12%.Conclusion Serum HE4 and CX⁃CL9 are highly expressed in LN.Combined detection has good diagnostic value and is an important prognostic factor.It can be used as a predictor of poor prognosis.