血浆免疫球蛋白结合蛋白 1 作为狼疮肾炎发展的预测因子。

Plasma immunoglobulin binding protein 1 as a predictor of development of lupus nephritis.

机构信息

Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Division of Rheumatology, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.

出版信息

Lupus. 2020 May;29(6):547-553. doi: 10.1177/0961203320912336. Epub 2020 Mar 17.

DOI:10.1177/0961203320912336

PMID:32183589

Abstract

OBJECTIVE

Urine levels of immunoglobulin binding protein 1 (IGBP1) are increased in patients with lupus nephritis (LN) compared with systemic lupus erythematosus (SLE) patients without nephritis. However, the clinical significance of IGBP1 level in plasma is unclear. We aimed to evaluate whether the plasma level of IGBP1 can predict future development of LN in SLE patients without nephritis.

METHODS

Forty-three SLE patients without nephritis were followed for 5 years. Plasma IGBP1 levels were measured using ELISA, and clinical and laboratory data were obtained at study entry. Development of LN was confirmed by renal biopsy. Cox regression analysis was performed to identify factors associated with development of LN, and receiver operating characteristic curve analysis was used to determine the predictive value of each factor.

RESULTS

Of the total 43 patients, eight (18.6%) developed LN during the follow-up period. Compared with patients who did not develop LN, those who developed LN had higher levels of plasma IGBP1 (6.3 ng/ml (range 4.3–9.6 ng/mL) vs. 13.3 ng/ml (range 7.2–31.3 ng/ml); p=0.023). In the Cox regression analysis, higher CRP (hazard ratio (HR)=1.325, 95% confidence interval (CI) 1.073–1.637, p=0.009), anti-dsDNA antibody (Ab; HR=1.066, 95% CI 1.012–1.124, p=0.017) and plasma IGBP1 (HR=1.091, 95% CI 1.034–1.152, p=0.002) were associated with future development of LN. Among these factors, anti-dsDNA Ab (area under the curve (AUC)=0.893) had the highest predictive value followed by plasma IGBP1 (AUC=0.761) and CRP (AUC=0.634). A combination of anti-dsDNA Ab and plasma IGBP1 as a composite predictor was highly specific (97%) for predicting the development of LN.

CONCLUSIONS

Plasma IGBP1 can be used complementarily with anti-dsDNA Ab for detecting SLE patients at a higher risk of developing LN.

摘要

目的

与无肾炎的系统性红斑狼疮（SLE）患者相比，狼疮肾炎（LN）患者的尿液免疫球蛋白结合蛋白 1（IGBP1）水平升高。然而，血浆中 IGBP1 水平的临床意义尚不清楚。我们旨在评估无肾炎的 SLE 患者血浆 IGBP1 水平是否可预测 LN 的未来发展。

方法

对 43 例无肾炎的 SLE 患者进行了 5 年的随访。使用 ELISA 法测定血浆 IGBP1 水平，并在研究入组时获取临床和实验室数据。通过肾活检证实 LN 的发生。采用 Cox 回归分析确定与 LN 发生相关的因素，并采用受试者工作特征曲线分析确定各因素的预测价值。

结果

在总共 43 例患者中，有 8 例（18.6%）在随访期间发生 LN。与未发生 LN 的患者相比，发生 LN 的患者血浆 IGBP1 水平更高（6.3ng/ml（范围 4.3-9.6ng/ml）vs. 13.3ng/ml（范围 7.2-31.3ng/ml）；p=0.023）。在 Cox 回归分析中，更高的 C 反应蛋白（CRP；危险比（HR）=1.325，95%置信区间（CI）1.073-1.637，p=0.009）、抗双链 DNA 抗体（Ab；HR=1.066，95%CI 1.012-1.124，p=0.017）和血浆 IGBP1（HR=1.091，95%CI 1.034-1.152，p=0.002）与 LN 的未来发生相关。在这些因素中，抗 dsDNA Ab（曲线下面积（AUC）=0.893）具有最高的预测价值，其次是血浆 IGBP1（AUC=0.761）和 CRP（AUC=0.634）。抗 dsDNA Ab 和血浆 IGBP1 的组合作为复合预测因子，对预测 LN 的发生具有高度特异性（97%）。