Department of Rheumatology, Shanghai Institute of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 145 Shandong (M) Rd, Shanghai, 200001, China.
Department of Biomedical Engineering, University of Houston, 3517 Cullen Blvd, Room 2027, Houston, TX, 77204-5060, USA.
Arthritis Res Ther. 2020 May 27;22(1):122. doi: 10.1186/s13075-020-02209-9.
Lupus nephritis (LN) is one of the most severe complications of SLE patients. We aim to validate urinary ALCAM as a biomarker in predicting renal disease histpathology in a Chinese lupus cohort.
In this cross-sectional study, a total of 256 patients and controls were recruited. Urinary levels of ALCAM were determined by ELISA. Renal histopathology was reviewed by an experienced renal pathologist.
Urinary ALCAM levels were significantly increased in active LN patients when compared to active SLE patients without renal involvement (p < 0.001), inactive LN patients (p = 0.023), inactive SLE patients without renal involvement (p < 0.001), and healthy controls (p < 0.001). Correlation analysis revealed a positive correlation between urinary ALCAM and general disease activity-SLEDAI score (r = 0.487, p < 0.001), as well as renal disease activity-rSLEDAI (r = 0.552, p < 0.001) and SLICC RAS (r = 0.584, p < 0.001). Urinary ALCAM also correlated with lab parameters including 24-h urine protein, hemoglobin, and complement 3. Moreover, urinary ALCAM levels were significantly increased in class III and IV (proliferative) LN as compared to those in class V (membranous) LN. It outperformed conventional biomarkers (anti-dsDNA antibody, C3, C4, proteinuria) in discriminating the two groups of LN. On renal histopathology, urinary ALCAM levels correlated positively with activity index (r = 0.405, p < 0.001) but not chronicity index (r = 0.079, p = 0.448).
Urinary ALCAM is a potential biomarker for predicting renal pathology activity in LN and may serve as a valuable surrogate marker of renal histopathology.
狼疮肾炎（LN）是系统性红斑狼疮（SLE）患者最严重的并发症之一。我们旨在验证尿 ALCAM 作为一种生物标志物在中国狼疮患者人群中预测肾脏疾病组织病理学的能力。
在这项横断面研究中，共招募了 256 名患者和对照者。通过 ELISA 测定尿 ALCAM 水平。由有经验的肾脏病理学家对肾脏组织病理学进行回顾性分析。
与无肾脏受累的活动期 SLE 患者（p<0.001）、活动期 LN 患者（p<0.001）、无肾脏受累的静止期 SLE 患者（p<0.001）和健康对照者（p<0.001）相比，活动期 LN 患者的尿 ALCAM 水平显著升高。相关性分析显示，尿 ALCAM 与一般疾病活动度-SLEDAI 评分（r=0.487，p<0.001）、肾脏疾病活动度-rSLEDAI（r=0.552，p<0.001）和 SLICC RAS（r=0.584，p<0.001）呈正相关。尿 ALCAM 也与 24 小时尿蛋白、血红蛋白和补体 3 等实验室参数相关。此外，与膜性 LN 相比，III 级和 IV 级（增殖性）LN 患者的尿 ALCAM 水平显著升高。与传统生物标志物（抗 dsDNA 抗体、C3、C4、蛋白尿）相比，它在鉴别这两组 LN 方面表现更优。在肾脏组织病理学方面，尿 ALCAM 水平与活动指数呈正相关（r=0.405，p<0.001），但与慢性指数无关（r=0.079，p=0.448）。
尿 ALCAM 是预测 LN 肾脏病理活动的潜在生物标志物，可能是肾脏组织病理学的有价值的替代标志物。
