血清白细胞介素-18水平升高可预测IgA肾病患者的疾病进展

目的探讨IgA肾病(IgAN)患者的血清白细胞介素(IL)-18水平与肾脏预后之间的关系。方法采用酶联免疫吸附法(ELISA)检测36例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 IgAN患者血清IL-18水平为(360.3±25.2)ng/L,显著高于健康对照者的(51.2±8.9)ng/L(P<0.01)。糖皮质激素治疗后,IgAN患者血清IL-18水平为(119.6±21.8)ng/L,较治疗前显著降低(P<0.001)。对lgAN患者进行19.0～62.4个月的前瞻性随访,中位随访期为38.7个月。随访期间14例(38.9%)患者出现肾功能减退。肾功能减退组患者治疗前、后IL-18水平分别为(364.45±40.25)、(132.44±32.40)ng/L,均显著高于肾功能稳定组的(353.67±16.36)、(99.41±24.14)ng/L(P值均<0.05)。Spearman相关分析显示,与随访期间肾小球滤过率(eGFR)降低的相关因素包括治疗前患者血清IL-18(r=-0.127,P=0.045)、血清肌酐(r=0.442,P=0.007)和eGFR(r=-0.845,P<0.001)。将以上所有变量纳入Logistic回归方程进行分析,治疗前IL-18水平(β=0.346,P=0.033)、eGFR(β=-0.41,P=0.013)是预测IgAN患者eGFR减退与否的重要危险因素。Kaplan-Meier生存分析结果显示,治疗前血清IL-18水平较高者的肾脏预后较差(P=0.008)。Cox回归分析进一步证实,治疗前血清IL-18水平(β=0.984,95%CI为0.926～1.042,P<0.001)及治疗前eGFR减退(β=1.021,95%CI为0.999～1.043,P=0.045)是预测肾脏预后的独立危险因素。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。

Elevated serum interleukin-18 levels may predict disease progression in IgA nephropathy

Objective To investigate the relationship between serum interleukin 18(IL-18) levels and prognosis of patients with IgA nephropathy(IgAN).Methods The serum IL-18 levels of 36 IgAN patients were measured by ELISA before and after treatment,and the prospective follow-up was carried out to evaluate the relationship between IL-18 levels and prognosis.Results The serum IL-18 level in IgAN patients was significantly higher than that in healthy controls([360.3±25.2] ng/L vs.[51.2±8.9] ng/L,P<0.01).After treatment with glucocorticoid,the serum IL-18 level in IgAN patients was decreased by(119.6±21.8) ng/L,which was significantly lower than that of pretreatment(P<0.001).During a median follow-up of 38.7(19.0—62.4) months,14 patients(38.9%) had a declined renal function.Compared with those who had a stable renal function,serum IL-18 levels before and after treatment were significantly increased in patients with renal function deterioration([364.45±40.25] ng/L vs.[353.67±16.36] ng/L,[132.44±32.40] ng/L vs.[99.41±24.14] ng/L,both P<0.05).Spearman correlation analysis showed that baseline serum IL-18 level(r=-0.127,P=0.045),serum creatinine(SCr,r=0.442,P=0.007) and glomerular filtration rate(eGFR,r=-0.845,P<0.001) were correlated with the decline of eGFR during the follow-up.Logistic regression analysis showed that baseline IL-18 levels(β=0.346,P=0.033) and eGFR(β=-0.41,P=0.013) were important risk predictors of eGFR decrease in IgAN patients.Kaplan-Meier analysis found that patients with elevated serum IL-18 levels had a poorer renal prognosis(P=0.008).Cox regression analysis further confirmed that elevated serum IL-18 levels(β=0.984,95%CI:0.926-1.042,P<0.001) and decreased eGFR(β=1.021,95%CI:0.999-1.043,P=0.045) before treatment were independent risk factors of disease progression.Conclusion Elevation of serum IL-18 levels prior to treatment may serve as an important biomarker for predicting disease progression in patients with IgAN.