Lai Lichuan, Wu Chunle, Li Xiaohua, Rong Yuxiang, Huang Ying, Wang Bangqin
Department of Laboratory, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
Department of Blood Transfusion, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
PLoS One. 2025 May 19;20(5):e0323334. doi: 10.1371/journal.pone.0323334. eCollection 2025.
Accurate diagnosis of lupus nephritis (LN) and effective assessment of its disease activity are essential for optimal management. This study aimed to evaluate the potential of novel urinary biomarkers, MCP-1 and VCAM-1, in diagnosing and assessing LN activity, comparing their efficacy to traditional urinary biomarkers, and proposing a new standard for clinical application.
A total of 55 LN patients who met the 1997 ACR diagnostic criteria for systemic lupus erythematosus (SLE) and 34 healthy controls (HCs) were included in this study. The LN patients were categorized into two groups based on their SLE disease activity indices (SLEDAI): the inactive lupus nephritis (NALN) group (SLEDAI 0-4, n = 32) and the active lupus nephritis (ALN) group (renal SLEDAI ≥ 4, n = 22). Additionally, the patients were further classified into mild (SLEDAI 5-9), moderate (SLEDAI 10-14), and severe (SLEDAI > 14) subgroups. All LN patients underwent testing for urinary MCP-1 (uMCP-1), urinary VCAM-1 (uVCAM-1), urinary α1-microglobulin (u-α1MG), urinary β2-microglobulin (u-β2MG), urinary IgG (u-IgG), and urinary albumin (u-ALB), as well as a percutaneous renal biopsy.
The levels of urinary MCP-1 and VCAM-1 (uMCP-1 and uVCAM-1) in the LN group were significantly elevated compared to the HCs (uMCP-1: P < 0.001; uVCAM-1: P < 0.01). Receiver operating characteristic (ROC) curve analysis revealed that the diagnostic efficacy of uMCP-1 and uVCAM-1 surpassed that of traditional biomarkers (uMCP-1: AUC = 0.79, P < 0.001; uVCAM-1: AUC = 0.77, P < 0.001). Multivariate logistic regression demonstrated a significant association between uMCP-1 and uVCAM-1 levels and the occurrence of LN (P < 0.001). Furthermore, these novel biomarkers exhibited stronger correlations with SLEDAI scores than traditional biomarkers (P < 0.001). Notably, patients with ALN had significantly higher levels of uMCP-1 and uVCAM-1 compared to those with NALN (uMCP-1: P < 0.01; uVCAM-1: P < 0.01).
The production of uMCP-1 and uVCAM-1 is closely associated with the onset and progression of LN (ISN/RPS: Class I - IV). These biomarkers may serve as valuable references for the diagnosis and prediction of LN and aid in the assessment of LN activity.
准确诊断狼疮性肾炎（LN）并有效评估其疾病活动度对于优化治疗至关重要。本研究旨在评估新型尿液生物标志物MCP-1和VCAM-1在诊断和评估LN活动度方面的潜力，将它们的效能与传统尿液生物标志物进行比较，并提出临床应用的新标准。
本研究纳入了55例符合1997年美国风湿病学会（ACR）系统性红斑狼疮（SLE）诊断标准的LN患者和34名健康对照（HCs）。根据SLE疾病活动指数（SLEDAI）将LN患者分为两组：非活动性狼疮性肾炎（NALN）组（SLEDAI 0 - 4，n = 32）和活动性狼疮性肾炎（ALN）组（肾脏SLEDAI≥4，n = 22）。此外，患者进一步分为轻度（SLEDAI 5 - 9）、中度（SLEDAI 10 - 14）和重度（SLEDAI>14）亚组。所有LN患者均接受尿液MCP-1（uMCP-1）、尿液VCAM-1（uVCAM-1）、尿液α1-微球蛋白（u-α1MG）、尿液β2-微球蛋白（u-β2MG）、尿液IgG（u-IgG）和尿液白蛋白（u-ALB）检测以及经皮肾活检。
与HCs相比，LN组尿液MCP-1和VCAM-1（uMCP-1和uVCAM-1）水平显著升高（uMCP-1：P < 0.001；uVCAM-1：P < 0.01）。受试者工作特征（ROC）曲线分析显示，uMCP-1和uVCAM-1的诊断效能超过传统生物标志物（uMCP-）：AUC = 0.79，P < 0.00；uVCAM-1：AUC = 0.77，P < 0.001）。多因素逻辑回归表明uMCP-1和uVCAM-1水平与LN的发生之间存在显著关联（P < 0.001）。此外，这些新型生物标志物与SLEDAI评分的相关性比传统生物标志物更强（P < 0.001）。值得注意的是，与NALN患者相比，ALN患者的uMCP-1和uVCAM-1水平显著更高（uMCP-1：P < 0.01；uVCAM-1：P < 0.01）。
uMCP-1和uVCAM-1的产生与LN（国际肾脏病学会/肾脏病理学会：I - IV级）的发病和进展密切相关。这些生物标志物可为LN的诊断和预测提供有价值的参考，并有助于评估LN活动度。
