正常人与原发性肾小球肾炎及狼疮性肾炎患者血尿IL-18水平比较

Comparison of Plasma and Urinary Interleukin-18 Levels in Normal Volunteers with those in Patients with Primary Glomerulonephritis and Lupus Nephritis

目的:探讨IL-18在原发性肾小球肾炎(PGN)及狼疮性肾炎(LN)发生、发展中的作用,以及寻找有助于两类疾病的鉴别诊断和对肾组织炎症活动程度进行评估的指标。方法:应用酶联免疫吸附检测(enzyme-linkedimmunosorbent assay,ELISA)法测定16例正常人、21例原发性肾小球肾炎(PGN)患者和18例LN患者血浆和尿液IL-18水平的变化。结果:LN患者血浆及尿液IL-18水平显著高于正常对照组(P均<0.001)和PGN组(P均<0.05),而且WHOⅣ型LN患者血浆及尿IL-18水平均明显高于非Ⅳ型LN患者(P<0.05);PGN患者尿液IL-18水平也高于正常人(P<0.05),但血浆IL-18水平与正常人比较无统计学差异(P>0.05);LN患者血浆IL-18水平与SLEDAI呈正相关(P<0.01),而尿IL-18水平与狼疮性肾炎RHSAI是密切正相关(P<0.001),但尿IL-18水平与血浆IL-18水平相关性没有统计学意义(P>0.05)。结论:IL-18参与LN的全身免疫病理过程,但可能仅参与PGN肾组织局部炎症过程;血浆IL-18检测可能有助于区分LN和PGN,尿IL-18的检测可望作为一项估计LN肾组织病变活动程度的有用指标。

Objective:To investigate the role of interleukin- 18(IL- 18) levels in development of primary glomeu-lonehpritis(PGN) and lupus nephritis(LN) ,and to seek for some usable parameters of differential diagnosis of PGN from LN and some indexes for evaluation the degree of inflammatory activity in PGN and LN. Methods: Plasma and urinary IL - 18 were measured by enzyme- linked immunosorbent assay(ELISA) in 16 normal volunteers,21 patients with PGN and 18 patients with LN. Results:Plasma and urinary concentrations of IL- 18 in patients with LN were significantly higher than those in normal controls (P<0.001) and patients with PGN(P<0. 05). Concentration of urinary IL- 18 in patient with PNS was higher than that in normal controls (P<0.05) ,but there was no statistical difference between PGN group and normal group in plasma IL- 18 levels. Furthermore, plasma and urinary concentrations of IL- 18 in patients with LN of type IV was significantly higher than those in patients with LN of other types(P<0. 05). Positive correlation was found between plasma IL- 18 concentrations and SLEDAI scores in patients with LN (P<0.01). Moreover, Close positive correlation was also found between urinary IL - 18 concentrations and renal histological scores of active index (RHSAI) in patient with LN (P<0.001). No significant correlation was found between plasma IL- 18 levels and urinary IL- 18 levels among patient with LN. Conclusion: IL - 18 might involve in the pathogenesis of LN in whole body system. While it might only involve renal tissue lesions in PGN. Plasma IL- 18 level can be acted as a usable parameter to distinguish PGN from LN. Urinary IL - 18 level can become a sensitive parameter to evaluate the degree of renal pathological activity.