IgA肾病患者尿液IL-6、IL-8、IL-33和MMP-9水平及其预测疾病进展的价值

Urine IL-6,IL-8,IL-33 and MMP-9 levels in patients with IgA nephropathy and their predictive value for disease progression

目的探讨IgA肾病(IgAN)患者尿液白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-33(IL-33)及基质金属蛋白酶-9(MMP-9)水平及其预测病情进展的价值。方法选取涿州市医院2018年1月至2021年10月收治的110例IgAN患者,根据IgAN患者的进展情况分为IgAN进展组(39例)和IgAN未进展组(71例)。根据IgAN牛津分型标准分为MEST-C≥3分组(42例)和MEST-C<3分组(68例),根据eGFR分为eGFR≥50 ml/(min·1.73 m^(2))组(A组,63例)和eGFR<50 ml/(min·1.73 m^(2))组(B组,47例),根据尿蛋白量分为尿蛋白量≥1.5 g/24 h组(66例)和尿蛋白量<1.5 g/24 h组(44例)。应用多因素logistic回归分析影响IgAN病情进展的危险因素。绘制受试者工作特征(ROC)曲线分析IL-6、IL-8、IL-33及MMP-9水平预测IgAN病情进展的价值。结果IgAN进展组尿IL-6、IL-8、IL-33及MMP-9水平均明显高于IgAN未进展组,而血清白蛋白、eGFR及补体C3水平均明显低于IgAN未进展组(均P<0.05)。MEST-C≥3分组尿IL-6、IL-8、IL-33及MMP-9水平均明显高于MEST-C<3分组(均P<0.001)。eGFR<50 ml/(min·1.73 m^(2))组尿IL-6、IL-8、IL-33及MMP-9水平均明显高于eGFR≥50 ml/(min·1.73 m2)组(均P<0.001)。尿蛋白量≥1.5 g/24 h组尿IL-6、IL-8、IL-33及MMP-9水平均明显高于尿蛋白量<1.5 g/24 h组(均P<0.001)。多因素logistic回归分析显示,病程、血清白蛋白、eGFR、尿蛋白量、IL-6、IL-8、IL-33及MMP-9是影响IgAN病情进展的危险因素(均P<0.005)。ROC曲线显示,IL-6、IL-8、IL-33及MMP-9四项联合预测IgAN病情进展的曲线下面积(AUC)高达0.956(95%CI:0.891~0.998),灵敏度和特异度分别为98.4%和86.2%。结论尿IL-6、IL-8、IL-33及MMP-9水平升高与IgAN病情进展密切相关,四项联合对预测IgAN病情进展具有较好的价值。

Objective To investigate the urineinterleukin-6(IL-6),interleukin-8(IL-8),interleukin-33(IL-33)and matrix metalloproteinase-9(MMP-9)in patients with IgA nephropathy(IgAN)and their predictive value for disease progression.Methods 110 IgAN patients admitted to Zhuozhou Hospital from January 2018 to October 2021 were selected and divided into IgAN progression group(39 cases)and IgAN non progression group(71 cases)according to the progress of IgAN patients.According to the Oxford Classification Standard System(MEST-C)of IgAN,they were divided into MEST-C≥3 group(42 cases)and MEST-C<3 group(68 cases).According to the estimated glomerular filtration rate(eGFR),they were divided into eGFR≥50 ml/(min·1.73 m^(2))group(group A,63 cases)and eGFR<50 ml/(min·1.73 m^(2))group(group B,47 cases).According to the amount of urinary protein,they were divided into urinary protein≥1.5 g/24 h group(66 cases)and urinary protein<1.5 g/24 h group(44 cases).Multivariate logistic regression was used to analyze the risk factors affecting the progression of IgAN.Receiver operating characteristic(ROC)curve was drawn to analyze the value of urinary IL-6,IL-8,IL-33 and MMP-9 levels in predicting the progression of IgAN.Results The urinary IL-6,IL-8,IL-33 and MMP-9 levels in IgAN progression group were significantly higher than those in IgAN non progression group,while the serum albumin,eGFR and complement C3 in the IgAN progression group were lower than those in the IgAN non progression group(all P<0.05).The urinary IL-6,IL-8,IL-33 and MMP-9 levels in the MEST-C≥3 group were significantly higher than those in the MEST-C<3 group(all P<0.001).The urinary IL-6,IL-8,IL-33 and MMP-9 levels in the eGFR<50 ml/(min·1.73 m2)group were significantly higher than those in the eGFR≥50 ml/(min·1.73 m^(2))group(all P<0.001).The urinary IL-6,IL-8,IL-33 and MMP-9 in the urinary protein≥1.5 g/24 h group were significantly higher than those in the urinary protein<1.5 g/24 h group(all P<0.001).Multivariate logistic regression analysis showed that the course of disease,serum albumin,eGFR,urinary protein,IL-6,IL-8,IL-33 and MMP-9 were risk factors affecting the progression of IgAN(all P<0.005).The ROC curve showed that the area under the curve(AUC)of IL-6,IL-8,IL-33 and MMP-9 in predicting the progression of IgAN was 0.956(95%CI:0.891-0.998),and the sensitivity and specificity were 98.4%and 86.2%,respectively.Conclusions The elevated levels of urinary IL-6,IL-8,IL-33 and MMP-9 are closely related to the progress of IgAN,and the combination of these four indicators has a good value in predicting the progress of IgAN.