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血清IL-18水平升高可预测IgA肾病患者的疾病进展
Elevated serum interleukin-18 levels may predict disease progression in IgA nephropathy

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DOI:
作者:
施蓓莉，倪兆慧，周敏捷，曹励欧，牟姗，王琴，张敏芳，吴青伟，戴慧莉，方炜，严玉澄，钱家麒
Shi Beili, Ni Zhaohui, Zhou Minjie, et al.
作者单位:
上海交通大学医学院附属仁济医院肾脏科
Shanghai Jiaotong University School of Medicine
关键词:
IgA肾病；白介素-18
IgA nephropathy；Interleukin 18
摘要:
目的：探讨IgA肾病（IgAN）患者的血清白介素-18（IL-18）水平与肾脏预后之间的关系。方法：使用酶联免疫吸附法（ELISA）检测IgAN患者治疗前后的血清IL-18水平，并对其进行前瞻性随访，评价IL-18与患者肾脏预后之间的关系。结果：共入选36例患者，其中男性17例，女性19例，平均年龄38.85±10.95岁，eGFR平均为75.83±4.41ml/min/1.73m2。与健康对照组相比，IgAN患者血清IL-18水平显著升高（360.3±25.2 vs 51.2±8.9 pg/ml, P<0.01），糖皮质激素治疗后血清IL-18水平较治疗前显著降低（119.6±21.8 vs 360.3±25.2, P<0.001）。患者平均随访38.74（19.00-62.40）月，随访期间14例（38.89%）患者出现肾功能减退。随访期间出现肾功能减退的患者治疗前血清IL-18水平（364.45±40.25 vs 353.67±16.36，P=0.02）、治疗后血清IL-18水平（132.44±32.40 vs 99.41±24.14，P=0.045）显著高于肾功能稳定患者。与随访期间肾小球滤过率（eGFR）降低的相关因素有治疗前患者的血清IL-18水平（r=-0.127，P=0.045）和初始肾功能的减退（r=-0.845，P<0.001）。Kaplan-Meier分析显示血清IL-18水平升高的患者肾脏预后显著较差（P=0.008），Cox回归分析进一步证实初始血清IL-18水平升高（β=0.984，95%CI 0.926-1.,042，P<0.001）和初始肾功能减退（β=1.021，95%CI 0.999-1.043，P=0.045）是预测IgAN患者肾脏预后不佳的独立危险因素。结论：治疗前IL-18水平升高可能是预测IgAN患者肾脏疾病进展的重要生物学标志物之一。
Objective. This study was aimed to investigate the relationship between serum interleukin 18 (IL-18) levels and disease progression in patients with IgA nephropathy (IgAN). Methods. We measured serum IL-18 levels of a cohort of IgAN patients by ELISA, and followed them up. Survival analysis was used to evaluate the relationship between IL-18 and renal outcome. Results. Totally 36 patients (age 38.85±10.95, 19 female) were enrolled. Compared with healthy controls, serum IL-18 levels were significantly elevated in IgAN patients. During a median of 38.74 (19.00-62.40) months follow-up, 14 patients (38.89%) had a declined renal function. Compared with those who had a stable renal function, serum IL-18 levels at baseline and post-steroid therapy were significantly higher in patients with renal function deterioration. Spearman correlation analysis showed that baseline serum IL-18 levels (r=-0.127，P=0.045) and eGFR (r=-0.845，P<0.001) were negatively correlated with the decline of eGFR. Kaplan-Meier analysis found those that patients with elevated serum IL-18 levels had a significant poorer renal outcome (P=0.008) and Cox analysis further confirmed that elevated serum IL-18 levels (β=0.984，95%CI 0.926-1.042，P<0.001) and decreased baseline renal function (β=1.021，95%CI 0.999-1.043，P=0.045) were independent predictor of disease progressionrenal outcome. Conclusions. Elevation of serum IL-18 levels may be closely associated with renal function deterioration and may serve as an biomarker of predicting renal disease progression in patients with IgAN.

 

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