血清肌酐和尿素氮及白细胞介素-21表达与肾病综合征患者临床疗效的关系研究

Study on relationship between expressions of serum creatinine,blood urea nitrogen and interleukin-21 and clinical efficacy in patients with nephrotic syndrome

目的分析血清肌酐(SCr)、尿素氮(BUN)、白细胞介素-21(IL-21)表达与肾病综合征患者临床疗效的关系。方法回顾分析2020年9月至2021年12月于九江市中医院九江市中医院就诊的108肾病综合征患者的临床资料,所有患者均给予一般治疗+对症治疗+糖皮质激素治疗方案,根据临床疗效分为有效组(n=85)与无效组(n=23)。比较两组治疗后血清SCr、BUN、IL-21表达水平,分析肾病综合征患者血清IL-21与SCr、BUN的相关性和肾病综合征患者血清SCr、BUN、IL-21水平与临床疗效的相关性及其对临床疗效的预测效能。结果有效组血清SCr、BUN、IL-21水平均低于无效组,差异有统计学意义(P<0.05)。经Pearson相关性分析结果显示,血清IL-21与SCr、BUN表达水平均呈正相关(r>0,P<0.05)。Logistic相关性分析结果显示,肾病综合征患者血清SCr、BUN、IL-21水平与临床疗效呈显著相关(P<0.05);ROC曲线分析结果显示,血清SCr、BUN、IL-21水平预测临床疗效的AUC均大于参考线(P<0.05),均有一定预测价值,其约登指数对应cut-off值分别为139.09μmol/L、12.79 mmol/L、85.77 ng/L。结论IL-21随着患者的肾功能下降而上升,SCr、BUN、IL-21水平高的肾病综合征患者常规治疗疗效不佳的风险更大,临床应监测上述指标变化并及时调整治疗方案,以改善患者预后。

Objective To analyze the relationship between expressions of serum creatinine(SCr),blood urea nitrogen(BUN)and interleukin-21(IL-21)and clinical efficacy in patients with nephrotic syndrome.Methods The clinical data of 108 patients with nephrotic syndrome who were treated in Jiujiang Hospital of Traditional Chinese Medicine from September 2020 to December 2021 were retrospectively analyzed,and all patients were given general treatment+symptomatic treatment+glucocorticoid therapy,and were divided into the effective group(n=85)and the ineffective group(n=23)according to clinical efficacy.The expression levels of serum SCr,BUN and IL-21 were compared between the two groups,and the correlation between serum IL-21 and SCr and BUN in patients with nephrotic syndrome,and the correlation among SCr,BUN,IL-21 and clinical efficacy in patients with nephrotic syndrome and predictive efficiency on clinical efficacy were analyzed.Results The levels of SCr,BUN and IL-21 in the effective group were lower than those in the ineffective group,and the differences were statistically significant(P<0.05).Pearson correlation analysis showed that serum IL-21 was positively correlated with SCr and BUN expression levels(r>0,P<0.05).Logistic correlation analysis results showed that serum SCr,BUN and IL-21 were significantly correlated with clinical efficacy in patients with nephrotic syndrome(P<0.05).ROC curve analysis results showed that the AUCs of serum SCr,BUN and IL-21 levels in predicting clinical efficacy were higher than the reference lines(P<0.05),and all of them had certain predictive value,and the corresponding cut-off values of the Youden index were 139.09μmol/L,12.79 mmol/L and 85.77 ng/L respectively.Conclusion IL-21 can increase with the decline of renal function of patients,and patients with nephrotic syndrome with high levels of SCr,BUN and IL-21 have a greater risk of poor efficacy of conventional treatment,it is necessary to monitor the changes of the above indicators in clinical practice and adjust the treatment regimen in time accordingly so as to improve the prognosis of patients.