进展性IgA肾病患者血清IL-18水平及来氟米特对其的影响

目的：观察进展性IgAN患者的血清白细胞介素-18（IL-18）水平,及来氟米特（LEF）治疗前后对其的影响。方法：将进展性IgAN患者随机分为来氟米特（LEF）组和激素组,使用酶联免疫吸附法（ELISA）检测其治疗前后的血清IL-18水平。结果：共36例患者完成为期12个月的随访,来氟米特联合激素治疗后可使蛋白尿水平显著降低,肾功能维持稳定。患者治疗前血清IL-18水平较对照组显著升高（360.3±25.2）vs（51.2±8.9）ng/L,P〈0.01],治疗显效者其水平显著降低。Logistic回归显示治疗前血清IL-18水平是预测进展性IgAN患者疗效的独立危险因素（β=-0.582,P=0.001）。结论：来氟米特可作为进展性IgA肾病的有效治疗方案,治疗前IL-18可能成为IgAN发病预测、疗效预判的一个无创指标。

Serum Interleukin-18 Levels in Progressive IgA Nephropathy and the Effects of Leflunomide on it

Objective：to investigate the levels of serum interleukin-18 （IL-18） and the effects of leflunomide on it in progressive IgA nephropathy.Methods：Patients with progressive IgA nephropathy were prospectively enrolled and randomly divided into the leflunomide （LEF） group and the corticosteroid group.We measured serum IL-18 levels by Enzyme-linked immunosorbent assay （ELISA）.Results：Thirty-six patients finished 12 months therapy （18 in LEF group and 18 in corticosteroid group）.There was no significant difference in baseline characteristics between the two groups.Compared with baseline levels,both groups showed significant improvement in proteinuria and serum albumin level （P0.01） while serum creatinine and estimated glomerular filtration rate （eGFR） remained stable. Serum IL-18 level was significantly elevated in IgAN patients than in the controls （360.3±25.2） vs （51.2±8.9）ng/L,P0.01].After treatment,serum IL-18 level was significantly decreased （141.3±37.9） vs （362.7±48.7）ng/L,P0.01],especially in those patients acquired remission.Logistic regression analysis found that IL-18 was an independent risk factor for predicting treatment effectiveness.Conclusion：Leflunomide might provide an alternative therapy in IgAN.Serum IL-18 might serve as a non-invasive method to predict the treatment outcome in this cohort.