血清白细胞介素-17A、趋化因子配体19水平与狼疮性肾炎患者疾病活动度的关系

The relationship between serum interleukin-17A,chemokine ligand 19 levels and disease activity in patients with lupus nephritis

目的探究血清白细胞介素17A(IL-17A)、趋化因子配体19(CCL19)水平与狼疮性肾炎患者疾病活动度的关系。方法采用回顾性研究的方法,选取济宁医学院附属医院2020年6月至2023年2月收治的狼疮性肾炎患者100例为疾病组,依据疾病活动指数将患者分为非活动组(32例)、轻度活动组(21例)、中度活动组(29例)、重度活动组(18例);另选取同期进行体检的健康者100例作为对照组。酶联免疫吸附法(ELISA)检测血清IL-17A、CCL19表达水平;Pearson法分析狼疮性肾炎患者血清IL-17A、CCL19与常规指标的相关性;受试者工作特征曲线分析血清IL-17A、CCL19对狼疮性肾炎疾病活动度为中/重度的诊断价值。结果疾病组血清IL-17A、CCL19表达水平均显著高于对照组[(252.63±64.47)ng/L比(123.27±25.12)ng/L、(566.98±73.36)ng/L比(275.63±50.48)ng/L](t=18.70、32.72,P<0.05);重度活动组、中度活动组、轻度活动组血清IL-17A和CCL19水平均高于非活动组[(331.42±87.46)、(278.50±74.19)、(232.34±59.16)ng/L比(198.18±46.22)ng/L,(662.33±89.57)、(606.14±79.25)、(552.84±68.36)ng/L比(487.13±62.19)ng/L],且随着疾病活动度的增加,血清IL-17A、CCL19水平均逐渐升高(F=17.86、25.35,P<0.05);活动组肾小球滤过率、白蛋白、补体C3、补体C4均显著低于非活动组[(69.17±13.25)ml/(min·1.73 m^(2))比(86.18±14.16)ml/(min·1.73 m^(2))、(24.18±5.11)g/L比(31.25±6.35)g/L、(432.35±95.22)mg/L比(675.42±125.16)mg/L、(76.58±17.51)mg/L比(121.42±27.18)mg/L],血肌酐、尿蛋白、红细胞沉降率均显著高于非活动组[(92.34±16.24)μmoI/L比(53.21±9.17)μmoI/L、(3.43±0.82)g/24 h比(1.26±0.23)g/24 h、(66.37±12.28)mm/1 h比(35.62±8.67)mm/1 h],差异均有统计学意义(t=5.86、5.97、10.74、9.93、12.70、14.67、12.74,均P<0.05);狼疮性肾炎患者血清IL-17A、CCL19与肾小球滤过率、白蛋白、补体C3、补体C4均呈负相关,与血肌酐、尿蛋白、ESR均呈正相关(P<0.05);血清IL-17A、CCL19二者联合诊断狼疮性肾炎疾病活动度的曲线下面积为0.961,优于各自单独诊断(Z=2.24和3.16,P=0.025和0.002)。结论血清IL-17A、CCL19表达水平随着狼疮性肾炎患者疾病活动度的增加而逐渐升高,二者联合检测对狼疮性肾炎疾病活动度有较好的诊断价值。

Objective To investigate the relationship between serum levels of interleukin-17A(IL-17A)and chemokine ligand 19(CCL19)and disease activity in patients with lupus nephritis.Methods A total of 100 patients with lupus nephritis admitted to Affiliated Hospital of Jining Medical College from June 2020 to February 2023 were collected as the disease group,according to the disease activity index,patients were grouped into inactive group(32 cases),mild active group(21 cases),moderate active group(29 cases),and severe active group(18 cases);another 100 healthy individuals who underwent physical examinations in our hospital during the same period were collected as the control group.Enzyme linked immunosorbent assay(ELISA)was applied to detect the expression levels of IL-17A and CCL19 in serum;Pearson method was applied to analyze the correlation between serum IL-17A,CCL19 and routine indicators in patients with lupus nephritis;receiver operating characteristic curve was applied to analyze the diagnostic value of serum IL-17A and CCL19 for moderate/severe lupus nephritis disease activity.Results The expression levels of IL-17A and CCL19 in the serum of the disease group were obviously higher than those of the control group:(252.63±64.47)ng/L vs.(123.27±25.12)ng/L and(566.98±73.36)ng/L vs.(275.63±50.48)ng/L(t=18.70 and 32.72,P<0.05);the serum levels of IL-17A and CCL19 in the severe active,moderate active,and mild active groups were higher than those in the inactive group:(331.42±87.46),(278.50±74.19)and(232.34±59.16)ng/L vs.(198.18±46.22)ng/L;(662.33±89.57),(606.14±79.25)and(552.84±68.36)ng/L vs.(487.13±62.19)ng/L,and with the increase of disease activity,the levels of serum IL-17A and CCL19 gradually increased(F=17.86 and 25.35,P<0.05);the glomerular filtration rate,albumin,complement C3 and complement C4 in the active group were obviously lower than those in the inactive group:(69.17±13.25)ml/(min·1.73 m^(2))vs.(86.18±14.16)ml/(min·1.73 m^(2)),(24.18±5.11)g/L vs.(31.25±6.35)g/L,(432.35±95.22)mg/L vs.(675.42±125.16)mg/L,(76.58±17.51)mg/L vs.(121.42±27.18)mg/L,while blood creatinine,urine protein and erythrocyte sedimentation rate were obviously higher than those in the inactive group:(92.34±16.24)μmoI/L vs.(53.21±9.17)μmoI/L,(3.43±0.82)g/24 h vs.(1.26±0.23)g/24 h,(66.37±12.28)mm/1 h vs.(35.62±8.67)mm/1 h(t=5.86,5.97,10.74,9.93,12.70,14.67 and 12.74;P<0.05);serum IL-17A and CCL19 in patients with lupus nephritis were negatively correlated with glomerular filtration rate,albumin,complement C3,and complement C4,while positively correlated with blood creatinine,urine protein,and ESR(P<0.05);the area under the curve(AUC)of the combined diagnosis of serum IL-17A and CCL19 for lupus nephritis disease activity was 0.961,which was superior to their respective individual diagnoses(Z=2.24 and 3.16,P=0.025 and 0.002).Conclusions The expression levels of IL-17A and CCL19 in serum gradually increase with the increase of disease activity in patients with lupus nephritis.The combined detection of the two has good diagnostic value for disease activity in lupus nephritis.