Xie Hua, Fang Ming, Lin Hongli, Li Ping, Chen Jilin, Sun Yanling, Kang Zhe
a Graduate School of Dalian Medical University , Dalian , China and.
b Division of Nephrology , the First Hospital of Dalian Medical University , Dalian , China.
Ren Fail. 2015 Jul;37(6):966-73. doi: 10.3109/0886022X.2015.1040698. Epub 2015 Sep 2.
Inflammation is a key part in the etiology and progression of idiopathic nephrotic syndrome (INS), we hypothesize that removing pro-inflammatory cytokines with intermittent high-volume hemofiltration (IHVHF) could improve the outcome in INS patients. The purpose of the current study is to examine whether IHVHF promotes remission in steroid-resistant INS. Fifty-one steroid-resistant INS patients were followed up on an open-label basis with prospective evaluations. Thirty-five patients received mycophenolate mofetil (SRD group) and 16 patients received drugs and IHVHF due to volume overload despite of diuretics (SRDF group). The rate of complete remission (CR) was analyzed. We also recruited 30 healthy individuals and 36 steroid-sensitive (SS) INS patients as controls to investigate the correlation of interleukin (IL)-8, IL-10, IL-6 and IL-17 with INS activity. Compared with the patients in the SRD group, the 6-month CR rate was higher (44% vs. 9%, p < 0.001) and time to first CR was significantly shorter (7.3 ± 3.6 vs. 11.1 ± 5.3 months, p = 0.02) in the SRDF group. Serum IL-8 was highest in the SRDF group and reduced by IHVHF clearance. Serum IL-8 was lower during remission than at onset or recurrence of INS, whereas no significant difference was seen in the other cytokines. Receiver operating characteristic curve analysis demonstrated that serum IL-8 predicted steroid sensitivity with moderate accuracy (area under the curve = 0.79, 95% CI: 0.69-0.87). IHVHF promotes remission in patients with steroid-resistant INS and it may be partly due to serum IL-8 clearance.
炎症是特发性肾病综合征（INS）病因及进展的关键部分，我们推测通过间歇性高容量血液滤过（IHVHF）清除促炎细胞因子可改善INS患者的预后。本研究的目的是检验IHVHF是否能促进激素抵抗型INS的缓解。对51例激素抵抗型INS患者进行开放标签的前瞻性随访评估。35例患者接受霉酚酸酯（SRD组），16例患者因尽管使用利尿剂但仍因容量超负荷接受药物及IHVHF治疗（SRDF组）。分析完全缓解（CR）率。我们还招募了30名健康个体和36例激素敏感（SS）型INS患者作为对照，以研究白细胞介素（IL）-8、IL-10、IL-6和IL-17与INS活动的相关性。与SRD组患者相比，SRDF组6个月CR率更高（44%对9%，p<0.001），首次CR时间显著更短（7.3±3.6对11.1±5.3个月，p=0.02）。SRDF组血清IL-8最高，经IHVHF清除后降低。INS缓解期血清IL-8低于发病或复发期，而其他细胞因子未见显著差异。受试者工作特征曲线分析表明，血清IL-8预测激素敏感性的准确性中等（曲线下面积=0.79，95%CI：0.69-0.87）。IHVHF可促进激素抵抗型INS患者的缓解，这可能部分归因于血清IL-8的清除。
