Department of Laboratory Medicine, Shengjing Hospital of China Medical University, China; Liaoning Clinical Research Center for Laboratory Medicine, China.
Department of Laboratory Medicine, The Second Affiliated Hospital of Dalian Medical University, China.
Int Immunopharmacol. 2022 Oct;111:109150. doi: 10.1016/j.intimp.2022.109150. Epub 2022 Aug 24.
We aimed to explore biomarkers of disease severity in idiopathic membranous nephropathy (IMN) and independent predictors of prognosis in IMN.
Clinical data were collected from 79 IMN patients. Serum levels of growth differentiation factor-15 (GDF-15) and soluble suppression of tumorigenicity (sST-2) were tested by enzyme-linked immunosorbent assay (ELISA) in IMN patients and subgroups, and correlation analysis was performed. Univariate and multiple logistic regression analyses were performed to identify independent predictors of IMN, and a combined-factors model was constructed. Moreover, the area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the prognostic efficacy.
The levels of GDF-15 were significantly higher in the IMN group and subgroups with low estimated glomerular filtration rate (eGFR) and high 24 hour-urine protein (24 h-UP), whiles sST-2 level was only significantly higher in the IMN group. GDF-15 levels were positively correlated with creatinine (Crea), cystatin C (Cys-C) and 24 h-UP and negatively correlated with GFR and albumin (Alb), while sST-2 levels were positively correlated with Urea and Cys-C and negatively correlated with eGFR. After one year of follow-up, 54 patients had incomplete remission. Serum phospholipase A2 receptor antibody (PLA2R-Ab), Urea, high-density lipoprotein cholesterol (HDL-C) and 24 h-UP but not GDF-15 and sST2 were independent predictors of prognosis in IMN patients, but combined factors showed the best prognostic efficacy.
Serum levels of GDF-15 and sST-2 may be potential biomarkers for the severity of IMN, while the combined-factors model is effective for predicting the risk factors of incomplete remission in IMN.
本研究旨在探讨特发性膜性肾病（IMN）患者疾病严重程度的生物标志物及影响 IMN 患者预后的独立预测因子。
收集 79 例 IMN 患者的临床资料。采用酶联免疫吸附试验（ELISA）检测 IMN 患者及各亚组血清生长分化因子 15（GDF-15）和可溶性肿瘤抑制物 2（sST-2）水平，并进行相关性分析。采用单因素及多因素 Logistic 回归分析识别影响 IMN 的独立预测因子，并构建联合因素模型。同时采用受试者工作特征（ROC）曲线下面积（AUC）评估预后效能。
IMN 组及估算肾小球滤过率（eGFR）降低和 24 小时尿蛋白（24 h-UP）升高亚组患者的 GDF-15 水平显著升高，而 sST-2 水平仅在 IMN 组升高。GDF-15 水平与肌酐（Crea）、胱抑素 C（Cys-C）和 24 h-UP 呈正相关，与 GFR 和白蛋白（Alb）呈负相关，sST-2 水平与 Urea 和 Cys-C 呈正相关，与 eGFR 呈负相关。随访 1 年，54 例患者未达完全缓解。血清磷脂酶 A2 受体抗体（PLA2R-Ab）、Urea、高密度脂蛋白胆固醇（HDL-C）和 24 h-UP 是影响 IMN 患者预后的独立预测因子，而联合因素模型的预测效能最佳。
血清 GDF-15 和 sST-2 水平可能是预测 IMN 严重程度的潜在生物标志物，联合因素模型可有效预测 IMN 患者不完全缓解的风险因素。
