Department of Allergy and Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University, 1678, Dongfang Road, Shanghai, China.
Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Jiao Tong University, Shanghai, China.
Pediatr Nephrol. 2018 May;33(5):837-845. doi: 10.1007/s00467-017-3867-1. Epub 2017 Dec 20.
Traditional serological biomarkers often fail to assess systemic lupus erythematosus (SLE) disease activity and discriminate lupus nephritis (LN). The aim of this study was to identify novel markers for evaluating renal and overall disease activity in Chinese patients with pediatric systemic lupus erythematosus (pSLE).
The study included 46 patients with pSLE (35 girls, 11 boys; average age 13.3 ± 2.6 years) and 31 matched healthy controls (22 girls, 9 boys; average age 12.3 ± 2.4 years). The SLE Disease Activity Index (SLEDAI) and renal SLEDAI were used to assess disease activity. Nine different soluble mediators in plasma, including tumor necrosis factor alpha (TNF-α), platelet-derived growth factor-BB (PDGF-BB), interferon (IFN) gamma inducible protein 10 (IP-10), interleukin (IL)-1β, IFN-γ, IL-17A, IL-2, Fas and Fas ligand, were measured by Luminex assay and compared between patients with active and inactive pSLE as well as between patients with pSLE with active and inactive renal disease. Receiver operating characteristic curve analysis was used to measure the discrimination accuracy.
Of the 46 patients with pSLE, 30 (65.2%) had LN. These patients had significantly elevated levels of serum TNF-α, PDGF-BB, IP-10 and Fas. The serum levels of IP-10 were also significantly higher in patients with active pSLE. We found that IP-10 was also more sensitive and specific than conventional laboratory parameters, including anti-double-stranded DNA and complement components C3 and C4, for distinguishing active lupus from quiescent lupus. The serum level of IP-10 was also significantly increased in children with pSLE with active renal disease relative to those with inactive renal disease. There was also a positive correlation between serum IP-10 levels and renal SLEDAI scores as well as with 24 h urine protein.
Serum IP-10 is useful for identifying renal and overall disease activity in children with pSLE.
传统的血清学生物标志物通常无法评估系统性红斑狼疮（SLE）疾病活动度，也无法区分狼疮肾炎（LN）。本研究旨在寻找新的生物标志物，以评估中国儿童系统性红斑狼疮（pSLE）患者的肾脏和整体疾病活动度。
本研究纳入 46 例 pSLE 患儿（35 名女性，11 名男性；平均年龄 13.3±2.6 岁）和 31 名匹配的健康对照者（22 名女性，9 名男性；平均年龄 12.3±2.4 岁）。采用 SLE 疾病活动指数（SLEDAI）和肾脏 SLEDAI 评估疾病活动度。通过 Luminex 分析检测血浆中 9 种不同的可溶性介质，包括肿瘤坏死因子-α（TNF-α）、血小板衍生生长因子-BB（PDGF-BB）、γ 干扰素诱导蛋白 10（IP-10）、白细胞介素（IL）-1β、干扰素（IFN）-γ、IL-17A、IL-2、Fas 和 Fas 配体，并比较活动期和非活动期 pSLE 患者以及有和无肾脏疾病活动的 pSLE 患者之间的差异。采用受试者工作特征曲线分析来测量鉴别准确性。
46 例 pSLE 患儿中 30 例（65.2%）患有 LN。这些患者的血清 TNF-α、PDGF-BB、IP-10 和 Fas 水平显著升高。活动期 pSLE 患者的血清 IP-10 水平也显著升高。我们发现，与抗双链 DNA 和补体成分 C3、C4 等常规实验室参数相比，IP-10 对于鉴别狼疮活动与静止更为敏感和特异。与肾脏无活动的患儿相比，有肾脏疾病活动的 pSLE 患儿的血清 IP-10 水平也显著升高。血清 IP-10 水平与肾脏 SLEDAI 评分以及 24 小时尿蛋白呈正相关。
血清 IP-10 可用于识别 pSLE 患儿的肾脏和整体疾病活动度。
