MCP-1、肾胺酶联合检测对狼疮性肾炎肾小管间质损伤的预测价值

Predictive value of MCP-1 combined with renalase assay for tubulointerstitial injury in lupus nephritis

目的研究血清单核细胞趋化因子(MCP-1)、肾胺酶联合检测在预测狼疮性肾炎(LN)的肾小管间质(TIN)损伤中的价值。方法将本院2017年1月至2021年8月收治的78例活动期LN患者纳为研究对象,设为观察组;同时将本院同期的50例健康体检合格者纳为对照组,所有患者均行肾组织活检,统计其TIN损伤病例数与病理病变情况,检测患者的血清MCP-1以及肾胺酶水平,分析血清MCP-1及肾胺酶在预测LN患者的TIN损伤中的价值。结果观察组患者的血清MCP-1以及肾胺酶水平均显著高于对照组(均P<0.05)。LN患者的血清MCP-1及肾胺酶水平与患者血肌酐、24 h尿蛋白定量水平呈正相关(均P<0.05),与eGFR水平呈负相关(均P<0.05),与患者性别、年龄无明显相关性(均P>0.05)。相关性分析提示,LN患者血清MCP-1及肾胺酶水平与其肾组织间质炎细胞浸润程度、肾小管萎缩程度、间质纤维化、肾小管上皮细胞变性程度、活动指数及慢性指数间均呈正相关(均P<0.05)。存在TIN损害的LN患者血清MCP-1及肾胺酶水平显著高于无TIN损害者(均P<0.05),且随着TIN损害程度的加重,患者血清MCP-1及肾胺酶水平均呈依次上升趋势(均P<0.05)。绘制受试者工作特征(ROC)曲线发现,血清MCP-1与肾胺酶联合应用预测LN患者TIN损害的效能高于各指标单独应用时的效能(AUC=0.86,95%CI:0.790~1.000)。结论血清MCP-1及肾胺酶在活动期LN患者TIN损害中均具有一定的预测效能,两者联合应用在预测活动期LN患者TIN损害中的价值较高,可作为临床筛查LN患者TIN损害的有效指标。

Objective To investigate the predictive value of monocyte chemoattractant protein-1(MCP-1)combined with renalase assay for tubulointerstitial injury(TIN)in lupus nephritis(LN).Methods A total of 78 patients with active LN admitted to our hospital from January 2017 to August 2021 were enrolled as the research objects and were set as the observation group.At the same time,50 healthy people who passed the physical examination in the hospital during the same period were enrolled as the control group.Renal tissue biopsy was performed for all the patients.The value of serum MCP-1 and renalase in predicting TIN injury in LN patients was analyzed.Results Serum MCP-1 and renalase levels of observation group were significantly higher than those of control group(all P<0.05).Serum MCP-1 and renalase levels in patients with LN were positively correlated with serum creatinine and 24 h urine protein quantitative levels(all P<0.05),negatively correlated with eGFR levels(all P<0.05),and there was no significant correlation with patient gender and age(all P>0.05).Correlation analysis showed that serum MCP-1 and renalase levels in LN patients were positively correlated with the degree of interstitial inflammatory cell infiltration,renal tubular atrophy,interstitial fibrosis,degeneration of renal tubular epithelial cells,activity index and chronicity index(all P<0.05).The levels of serum MCP-1 and renalaes in LN patients with TIN damage were significantly higher than those in LN patients without TIN damage(all P<0.05),and the levels of serum MCP-1 and renalase increased in turn with the aggravation of TIN damage(all P<0.05).The receiver operating characteristic(ROC)curve showed that serum MCP-1 and renalase had certain value in predicting TIN damage in LN patients,and the combination of the two could effectively improve the efficacy of each index when used alone(AUC=0.86,95%CI:0.790-1.000).Conclusions Serum MCP-1 and renalase have certain efficacy in TIN damage in active LN patients,and the combined application of the two has a high value in predicting TIN damage in patients with active LN,which can be used as an effective indicator for clinical screening of TIN damage in patients with LN.