尿可溶性CD163水平在狼疮性肾炎患者中的表达及诊断价值

Expression and correlation of urinary soluble CD163 levels in patients with lupus nephritis

目的研究系统性红斑狼疮(SLE)及狼疮性肾炎(LN)患者中尿液可溶性CD163水平的表达,探讨其与LN的疾病活动相关性及诊断价值。方法选取九江市第一人民医院确诊的LN、非LN的SLE、非LN肾小球肾炎及健康对照人群,检测基线及随访3、6、12个月的CD163水平。分析尿CD163水平与蛋白尿、临床活动度、疾病转归、病理类型和免疫学指标等之间的关系。ROC曲线评估尿CD163水平对活动性LN的预测价值。logisitic多因素回归分析尿CD163水平对LN患者完全缓解的影响。结果LN患者尿CD163水平明显高于活动性肾外SLE、非活动性SLE及非LN肾小球疾病患者,与疾病的临床严重程度、病理类型有关(P<0.001),且随免疫应答的反应逐渐减少(P<0.001)。尿CD163水平诊断活动性LN的ROC曲线下面积为0.971,临界值为98.5 ng/mmol,敏感性为85.7%,特异性为96.4%。logisitic多因素回归分析得出,矫正性别、年龄、uPCR、eGFR、C3等因素,6个月时尿CD163<205 ng/mmol是LN患者12个月临床缓解的独立影响因素(OR=2.173,P=0.021)。结论尿CD163水平在LN中的表达与其临床活动度及治疗转归有关,并且可用于诊断活动性LN。

Objective To investigate the expression of urinary soluble CD163 levels in patients with systemic lupus erythematosus(SLE)and lupus nephritis(LN),as well as its disease activity and outcome correlation with LN.Methods LN,SLE patients from Jiujiang First People′s Hospital and a healthy control population were tested for CD163 levels at baseline and 3,6,and 12 months later.The relationship between urinary CD163 levels and the degree of proteinuria,clinical activity,disease outcome,pathological type,and immunological indicators were analyzed.The ROC curve assessed the predictive value of urinary CD163 levels for LN.Logisitic multiple regression analysis of the effect of urinary CD163 levels on complete response in LN patients.Results The urinary CD163 level in LN patients was significantly higher than that of active SLE,inactive SLE and non-LN glomerular disease,and the clinical severity and pathological type of the disease also varied(P<0.001),and Urinary CD163 response gradually decreases along with the immune response(P<0.001).The area under the ROC curve for urinary CD163 level was 0.971(P<0.001),>98.5 ng/mmol with 85.7%sensitivity and 96.4%specificity.After adjusting for gender,age,uPCR,eGFR,C3,urinary CD163&lt;205 ng/mmol was found to be an independent predictor of 12 months of clinical remission in LN patients(OR=2.173,P=0.021).Conclusion Urinary CD163 expression in LN is related to clinical activity and treatment outcome,and it is a novel and valuable active biomarker.