天津医药

天津医药 ›› 2022, Vol. 50 ›› Issue (2): 171-176.doi: 10.11958/20211707

• 临床研究 • 上一篇    下一篇

血清中性粒细胞胞外诱捕网水平与狼疮性肾炎的相关性 #br#

韩敬，顾津伊，刘裔，秦源，赵玲华
  

  1. 1云南大学附属医院（云南省第二人民医院、云南省眼科医院）肾内科（邮编650032），2检验科；3山西省肿瘤医院感染控制科
  • 收稿日期:2021-07-22 修回日期:2021-08-13 出版日期:2022-02-15 发布日期:2022-02-15
  • 通讯作者: 韩敬 E-mail:hanj19780@163.com
  • 基金资助:
    云南省科技厅科技计划项目（2018FE0010）

Study on the correlation between serum neutrophil extracellular trap level and lupus nephritis #br#

HAN Jing, GU Jinyi, LIU Yi, QIN Yuan, ZHAO Linghua #br#   

  1. 1 Department of Nephrology, 2 Department of Laboratory, the Affiliated Hospital of Yunnan University (The Second People's
    Hospital of Yunnan, Yunnan Eye Hospital), Kunming 650032, China; 3 Infection Control Division, Shanxi Cancer Hospital
  • Received:2021-07-22 Revised:2021-08-13 Published:2022-02-15 Online:2022-02-15

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摘要： 目的 探讨血清中性粒细胞胞外诱捕网（NETs）水平与狼疮性肾炎（LN）病情以及预后的关系，分析NETs 预测LN预后的价值。方法 选取92例LN患者（LN组），97例肾功能和尿检正常的SLE患者（SLE组）和83例健康志 愿者（对照组）。根据系统性红斑狼疮疾病活动度评分（SLEDAI）-2000 将 LN 患者分为轻度活动组（评分≤6 分，31 例），中度活动组（评分7~12分，33例）和重度活动组（评分＞12分，28例）。根据随访期间肾脏相关终点事件发生情 况将LN患者分为预后不良组（25例）和预后良好组（67例）。检测血清NETs水平，分析NETs与脱氧核糖核酸酶1 （DNASE1）、肾功能、SLEDA1-2000评分、肾组织活动性指数（AI）和慢性指数（CI）评分的相关性，多因素Logistic回归 分析影响LN预后的因素，受试者工作特征（ROC）曲线分析NETs预测LN患者预后的价值。结果 LN组血清NETs 水平高于SLE组和对照组，重度活动组血清NETs水平高于中度活动组和轻度活动组，中度活动组血清NETs水平高 于轻度活动组（P＜0.05）。NETs 水平与肾小球滤过率（eGFR）和 DNASE1 呈负相关，与 24 h 尿蛋白定量、SLEDA1- 2000 评分、肾组织 AI 评分和 CI 评分呈正相关（P＜0.05）。高 AI 评分和高 NETs 是 LN 预后不良的危险因素（P＜ 0.05）。NETs预测LN患者预后的曲线下面积（AUC）为0.871，敏感度为80.00%，特异度为86.57%。结论 NETs水平 升高与LN肾损伤程度以及肾脏终点事件发生有关，可作为LN预后评估的指标。

关键词: 狼疮肾炎, 红斑狼疮, 系统性, 胞外诱捕网, 中性白细胞, 脱氧核糖核酸酶Ⅰ, 肾功能不全

Abstract: Objective To investigate the relationship between serum neutrophil extracellular traps (NETs) and the prognosis of lupus nephritis (LN), and to analyze the prognostic value of NETs in LN. Methods There were 92 patients with LN (the LN group), 97 patients with systemic lupus erythematosus (SLE) and normal renal function (the SLE group), and 83 healthy volunteers (the control group) in this study. According to SLEDAI-2000 score, LN patients were divided into the mild activity group (score≤6, n=31), the moderate activity group (score7-12, n=33), the severe activity group (score＞12, n= 28). According to the occurrence of renal endpoint events during the follow-up period, LN patients were divided into the poor prognosis group (n=25) and the good prognosis group (n=67). Levels of serum NETs were detected to analyze the correlation between NETs and deoxyribonuclease 1 (DNASE1), renal function, SLEDAI-2000 score, renal tissue activity index (AI) and chronic index (CI) scores. Logistic regression was used to analyze the factors affecting the prognosis of LN, and receiver operating characteristic curve (ROC) was used to analyze the prognosis value of NETs in patients with LN. Results The serum level of NETs was higher in the LN group than that of the SLE group and the control group. The serum level of NETs was higher in the severe activity group than that of the moderate activity group and the mild activity group. The serum NETs level was higher in the moderate activity group than that of the mild activity group (P＜0.05). Levels of NETs were negatively correlated with glomerular filtration rate (eGFR) and DNASE1 (r=-0.769), and positively correlated with 24 h urinary protein quantification, SLEDAI-2000 score, renal tissue AI and CI (P＜0.05). High AI score and high NETs were risk factors for poor prognosis of LN (P＜0.05). The area under curve (AUC) of NETs for predicting prognosis in patients with LN was 0.871, with a sensitivity of 80.00% and a specificity of 86.57%. Conclusion Elevated levels of NETs are associated with degree of renal injury and renal end point events in LN, and can be used as a prognostic indicator for LN.

Key words: lupus nephritis, lupus erythematosus, systemic, extracellular traps, neutrophils, deoxyribonuclease Ⅰ,  renal insufficiency