摘要
背景IgA血管炎(IgAV)的长期预后取决于肾脏损伤的程度,有关IgAV肾损害发病机制的研究发现细胞因子在介导、驱动肾脏的损伤过程中发挥了重要作用。目的通过研究IgAV及肾损害患儿血清细胞因子水平变化,探讨细胞因子在IgAV肾损害过程中的意义和价值。方法选取2018年1月至2020年6月于中国医科大学附属盛京医院小儿肾脏内科住院的IgAV患儿194例作为研究对象,根据有无肾脏损害分为IgAV肾损害组(n=97),IgAV组(n=97),选取同时期本院儿童保健科进行体检的健康儿童60例为对照组。收集受试儿童及患儿细胞因子〔白介素(IL)-2、IL-4、IL-6、IL-10、IL-17、干扰素γ(IFN-γ)及肿瘤坏死因子α(TNF-α)〕以及患儿淋巴细胞绝对计数、免疫球蛋白A、免疫球蛋白E。采用多因素Logistic回归分析探讨IgAV肾损害的影响因素,绘制细胞因子对IgAV肾损害诊断价值的受试者工作特征(ROC)曲线。结果lgAV组IL-2水平高于lgAV肾损害组、对照组,且lgAV肾损害组IL-2水平高于对照组(P<0.05);lgAV肾损害组IL-17水平高于lgAV组、对照组,lgAV组IL-17水平高于对照组(P<0.05);lgAV组IL-6、IL-10和TNF-α水平高于lgAV肾损害组和对照组(P<0.05);lgAV肾损害组和对照组IFN-γ水平高于lgAV组(P<0.05)。多因素Logistic回归分析结果显示,IL-2、IL-17、IFN-γ、TNF-α是IgAV肾损害发生的影响因素(P<0.05)。IL-2预测IgAV肾损害的ROC曲线下面积(AUC)为0.589,灵敏度为38.0%,特异度为47.0%;IL-17预测IgAV肾损害的AUC为0.621,灵敏度为47.4%,特异度为77.3%;IFN-γ预测IgAV肾损害的AUC为0.688,灵敏度为75.0%,特异度为55.7%;TNF-α预测IgAV肾损害的AUC为0.614,灵敏度为42.0%,特异度为37.0%;IL-17和IFN-γ联合预测IgAV肾损害的AUC为0.710,灵敏度为71.1%,特异度为66.0%。结论细胞因子IL-17、IFN-γ与IgAV肾损害的发生密切相关,早期检测两者水平并动态监测其变化,可对肾脏受累的早期发现及调整治疗方案起到预警作用。
Background The long-term prognosis of IgA vasculitis(IgAV)depends on thedegreeof renal damage.Studies on the pathogenesis of renal injury in IgAV have found that cytokines play an important role in mediating and driving the process of renal damage.Objective To investigate the significance and value of cytokine in the process of renal damage in IgAV by exploring the changes of serum cytokine level in children with IgAV renal damage.Methods 194 IgAV children hospitalized in the Department of Pediatric,Shengjing Hospital of China Medical University from January 2018 to June 2020 were selected as research subjects.They were divided into IgAV group(n=97)and IgAV renal damage group(n=97)according to the presence or absence of renal damage,and 60 healthy children who underwent physical examination in the pediatric health department of our hospital during the same period were selected as the control group.The cytokines(IL-2,IL-4,IL-6,IL-10,IL-17,IFN-γ,and TNF-α),absolute lymphocyte count,immunoglobulin A,and immunoglobulin E were collected from the children.Multivariate Logistic regression was used to analyze the factors influencing IgAV renal damage,and the receiver operating curve(ROC)of the diagnostic value of cytokines on the characteristics of IgAV renal damage was drawn.Results The IL-2 level in the lgAV group were higher than those in the lgAV renal damage group and the control group,and the IL-2 level in the lgAV renal damage group was higher than that in the control group(P<0.05);IL-17 level in the lgAV renal damage group were higher than those in the lgAV group and the control group,and IL-17 level in the lgAV group was higher than that in the control group(P<0.05);IL-6,IL-10,and TNF-αlevel were higher in the lgAV renal damage group than those in the lgAV renal damage group and the control group(P<0.05);IFN-γlevel were higher in the lgAV renal damage group and the control group than that in the lgAV group(P<0.05).Multivariate Logistic regression analysis showed that IL-2,IL-17,IFN-γ,and TNF-αwere influencing factors in developing IgAV renal damage(P<0.05).The AUC of IL-12 for predicting IgAV renal damage was 0.589,with a sensitivity of 38.0%and specificity of 47.0%.The AUC of IL-17 for predicting IgAV renal damage was 0.621,with a sensitivity of 47.4%and specificity of 77.3%.The AUC of IFN-γfor predicting IgAV renal damage was 0.688,with a sensitivity of 75.0%and specificity of 55.7%.The AUC of TNF-αfor predicting IgAV renal damage was 0.614,with a sensitivity of 42.0%and specificity of 37.0%.The AUC of IL-17 and IFN-γcombined for predicting IgAV renal damage was 0.710,with a sensitivity of 71.1%and specificity of 66.0%.Conclusion Serum cytokines IL-17 and IFN-γare closely associated with the development of renal damage in IgA vasculitisrenal damage,early detection of both levels and dynamic monitoring of their changes can serve as an early warning for early detection of renal involvement and adjustment of treatment plans.
作者
王孟迪
杜悦
WANG Mengdi;DU Yue(Department of Pediatrics,Shengjing Hospital of China Medical University,Shenyang 110000,China)
出处
《中国全科医学》
CAS
北大核心
2022年第8期973-978,共6页
Chinese General Practice
作者简介
通信作者:杜悦,教授,E-mail:duy@sj-hospital.org。
