Dong X W, Zheng Z H, Ding J, Luo X, Li Z Q, Li Y, Rong M Y, Fu Y L, Shi J H, Yu L C, Wu Z B, Zhu P
1 Department of Clinical Immunology, Branch of Immune Cell Biology, State Key Discipline of Cell Biology, PLA Specialized Research Institute of Rheumatology & Immunology, Xijing Hospital, 12644 Fourth Military Medical University , Xi'an, Shaanxi Province, People's Republic of China.
2 National Translational Science Center for Molecular Medicine, Xi'an, People's Republic of China.
Lupus. 2018 May;27(6):971-981. doi: 10.1177/0961203318758507. Epub 2018 Feb 16.
Reliable markers for the rapid discrimination of severe renal damage remain a vital concern for lupus nephritis (LN). To determine a better tool for kidney damage detection, the present study compared the evaluation ability of novel urinary cytokines and chemokines (namely urinary monocyte chemoattractant protein 1 (uMCP-1), tumor necrosis factor-like weak inducer of apoptosis (uTWEAK)) with traditional serum or urinary markers (namely urinary alpha 1-microgrobulin (uα1-MG), beta 2-microglobulin (uβ2-MG) and serum complement C3 (C3), complement C4 (C4), creatinine (Cr), blood urea nitrogen (BUN) and cystatin C (Cys C)) in discriminating LN renal damage. Correlations between markers with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) renal SLEDAI scores, biopsy activity index (BAI) and biopsy chronicity index (BCI) scores were evaluated. Receiver operating characteristic (ROC) curves were generated to evaluate a single or combined model in discriminating active renal involvement (rSLEDAI scores > 0) and patients with poor pathological outcome (BAI scores ≥ 7). uMCP-1 and uTWEAK possess higher correlation coefficients with renal damage and larger areas under ROC curves (AUCs) than other markers. A combined model of uMCP-1 and uTWEAK showed an AUC of 0.887, sensitivity of 86.67% and specificity of 80.00% to discriminate active LN, and an AUC of 0.778, sensitivity of 75.00% and specificity of 81.82% to discriminate LN with poor outcome, which are better than the utility of any markers individually.
用于快速鉴别严重肾损伤的可靠标志物仍是狼疮性肾炎（LN）的一个重要关注点。为了确定一种更好的肾脏损伤检测工具，本研究比较了新型尿细胞因子和趋化因子（即尿单核细胞趋化蛋白1（uMCP-1）、肿瘤坏死因子样凋亡弱诱导剂（uTWEAK））与传统血清或尿标志物（即尿α1-微球蛋白（uα1-MG）、β2-微球蛋白（uβ2-MG）以及血清补体C3（C3）、补体C4（C4）、肌酐（Cr）、血尿素氮（BUN）和胱抑素C（Cys C））在鉴别LN肾损伤方面的评估能力。评估了这些标志物与系统性红斑狼疮疾病活动指数（SLEDAI）、肾脏SLEDAI评分、活检活动指数（BAI）和活检慢性指数（BCI）评分之间的相关性。生成了受试者工作特征（ROC）曲线，以评估单一或联合模型在鉴别活动性肾受累（rSLEDAI评分>0）和病理结果较差（BAI评分≥7）患者方面的性能。与其他标志物相比，uMCP-1和uTWEAK与肾损伤的相关系数更高，ROC曲线下面积（AUC）更大。uMCP-1和uTWEAK的联合模型在鉴别活动性LN时，AUC为0.887，敏感性为86.67%，特异性为80.00%；在鉴别预后较差的LN时，AUC为0.778，敏感性为75.00%，特异性为81.82%，均优于任何单个标志物的效用。
