血清TLR4和PTEN与特发性膜性肾病患者临床病理特征及预后的相关性

Correlation between serum TLR4 and PTEN and clinicopathologic characteristics and prognosis in patients with idiopathic membranous nephropathy

目的 探究血清Toll样受体4(TLR4)、第10号染色体缺失性磷酸酶和张力蛋白同源物基因(PTEN)与特发性膜性肾病(IMN)患者临床病理特征及预后的相关性。方法 选取2019年1月至2022年1月在河北以岭医院就诊治疗的IMN患者224例为IMN组,同时根据其预后结果将其分为预后良好组174例、预后不良组50例;另选取同期在本院体检健康者100名作为对照组。采用酶联免疫吸附法(ELISA)检测研究对象血清TLR4、PTEN水平;采用pearson分析IMN患者血清TLR4水平和PTEN水平相关性;多因素Logistic回归分析IMN患者预后不良的影响因素;受试者工作特征曲线(ROC)分析血清TLR4和PTEN在评估IMN患者预后中的价值。结果 IMN组血清TLR4、PTEN水平较对照组均显著升高,差异有统计学意义(t=12.918,13.249,P<0.05);预后不良组血清TLR4、PTEN水平较预后良好组均显著升高,差异有统计学意义(t=11.608,12.965,P<0.05);IMN患者血清TLR4与PTEN水平呈正相关;TLR4、PTEN、IgG、合并高血压均为IMN患者预后不良的独立危险因素(P<0.05);血清TLR4、PTEN水平预测IMN患者预后是否不良的曲线下面积(AUC)分别为0.878、0.868,两者联合预测的AUC为0.941,高于两者单独预测(z=1.874、2.065,P<0.05),且特异度为0.89,灵敏度为0.88。结论 血清TLR4、PTEN水平与IMN患者分期,肾小球硬化,二者对IMN预后具有一定的预测价值。

Objective To explore the correlation between serum Toll-like receptor 4(TLR4),phosphatase and tensin homologue-deleted chromosome ten gene(PTEN)and the clinicopathologic characteris-tics and prognosis of patients with idiopathic membranous nephropathy(IMN).Methods A total of 224 IMN patients were treated at Hebei Yiling Hospital from January 2019 to January 2022.These patients were divided into two groups based on their prognosis:174 patients in the good prognosis group and 50 patients in the poor prognosis group.Additinoally,100 healthy individuals from our hospital were included as the control group.The levels of serum TLR4 and PTEN in the subjects were measuredusing enzyme-linked immunosorbent assay(ELISA).Pearson correlation aanalysis was used to examine the relationship between serum TLR4 levels and PTEN levels in IMN patients.Multivariate logistic regression was employed to identify the factors influencing poor prognosis in IMN patients.Furthermore,the potential of serum TLR4 and PTEN as prognosis markers for IMN patients was evaluated using receiver operating characteristic(ROC)curve analysis.Results The levels of serum TLR4 and PTEN in the IMN group were higher than those in the control group,and the differences were statistically significant(t=12.918,13.249,P<0.05).Simarly,the serum levels of TLR4 and PTEN in the poor prognosis group were significantly higher than those in the good prognosis group,and the differences were statistically significant(t=11.608,12.965,P<0.05).There was a positive correlation between serum TLR4 and PTEN levels in IMN patients.High levels of TLR4,PTEN,IgG and hypertension were identified as independent risk factors for poor prognosis in IMN patients(P<0.05).The area under the curve(AUC)for se-rum TLR4 and PTEN levels in predicting poor prognosis in IMN patients were 0.878 and 0.868,respectively.When combined,the AUC increased to 0.941,which was significantly higher than the AUC predicted by the two alone(z=1.874 and 2.065,P<0.05).The specificity was 0.89,and the sensitivity was 0.88.Conclusion Serum levels of TLR4 and PTEN are closely associated with the staging of patients with IMN,as well as with glomerulosclerosis.These factors also have a certain predictive value for the prognosis of IMN.