狼疮性肾炎患者血清NGAL、MCP-1、TWEAK的表达及临床意义

Expression and clinical significance of serum neutrophil gelatinase-associated lipocalin,monocyte chemoattractant protein-1 and tumor necrosis factor-like weak inducer of apoptosis in patients with lupus nephritis

目的研究狼疮性肾炎(LN)患者血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、单核细胞趋化蛋白-1(MCP-1)和肿瘤坏死因子样凋亡微弱诱导剂(TWEAK)的表达及其临床意义。方法选取97例从2016年1月至2019年12月在汉中三二〇一医院接受诊治的LN患者作为研究对象。其中活动期组38例与非活动期组59例,选取51例健康体检者作为对照组,对比各组血清NGAL、MCP-1、TWEAK的水平与肾功能指标的水平,通过受试者工作特征(ROC)曲线评价血清NGAL、MCP-1、TWEAK表达对LN疾病活动性的诊断价值。结果活动期组和非活动期组患者的血清NGAL、MCP-1、TWEAK、血肌酐(Scr)、尿素氮(BUN)、24 h尿蛋白、dsDNA水平高于对照组,且活动期组以上各指标均高于非活动期组(P<0.05)。Pearson相关分析提示,LN患者血清NGAL、MCP-1、TWEAK水平与系统性红斑狼疮疾病活动度评分(SLEDAI)、Scr、BUN、24 h尿蛋白和dsDNA水平呈正相关(P<0.05)。ROC曲线分析可得:联合血清NGAL、MCP-1、TWEAK预测LN患者疾病活动性的曲线下面积(AUC)为0.865,特异度、灵敏度、AUC、约登指数均高于单一指标。结论LN患者活动期时血清NGAL、MCP-1、TWEAK表达水平升高,且与疾病的活动性密切相关,对于预测LN的活动性具有较高的应用价值,可作为临床预测LN活动期的生物标志物。

Objective To study the expression and clinical significance of serum neutrophil elatinase-associated lipocalin(NGAL),monocyte chemoattractant protein-1(MCP-1)and tumor necrosis factor-like weak inducer of apoptosis(TWEAK)in patients with lupus nephritis(LN).Methods 97 LN patients who received treatment in Hanzhong 3201 Hospital from January 2016 to December 2019 were selected as study objects.Among them,38 cases were in the active group and 59 cases were in the inactive group,and 51 cases for physical examination were selected as the control group.The levels of serum NGAL,MCP-1,TWEAK and LN renal function was examined and compared in each group.The diagnostic value of serum NGAL,MCP-1 and TWEAK expression on LN disease activity was evaluated by receiver operating characteristic(ROC)curve.Results The levels of serum NGAL,MCP-1,TWEAK,serum creatine(Scr),blood urea nitrogen(BUN),24 h urinary protein and dsDNA in the active and inactive groups were higher than those in the control group,and the above indexes in the active group were higher than those in the inactive group(P<0.05).Pearson correlation analysis showed that serum NGAL,MCP-1 and TWEAK levels in LN patients were positively correlated with systemic lupus erythematosus disease activity index(SLEDAI)score,Scr,BUN,24 h urine protein and dsDNA levels(P<0.05).ROC curve analysis showed that the area under curve(AUC)of combined serum NGAL,MCP-1 and TWEAK in predicting disease activity of LN patients was 0.865,and the specificity,sensitivity,AUC and Youden index were higher than single index.Conclusions The expression of NGAL,MCP-1 and TWEAK in LN patients during the active period is increased and closely related to the activity of disease.It is of high application value for predicting LN activity,and can be used as biomarkers for clinical prediction of LN activity.