目的: 分析铁代谢相关指标在评价狼疮性肾炎（lupus nephritis,LN）病情和预后中的价值。方法: 这是一项在本院进行的单中心、横断面、观察性队列研究,研究时间为2021年1月到2022年6月,研究对象为101例系统性红斑狼疮（systemic lupus erythematosus,SLE）患者和11例健康对照。比较SLE患者和对照组的基线尿铁蛋白水平和肾损伤分子1（KIM-1）蛋白水平,并与临床特征和随后的治疗反应进行相关分析。结果: 与活动性非肾炎（active nonphritis,ANR）组患者相比,活动性狼疮性肾炎（active lupus-nephritis,ALN）患者更年轻,女性比例、蛋白尿、肾脏SLEDAI评分（renal SLEDIA,rSLEDAI）、系统性红斑狼疮疾病活动指数（SLEDAI）更高和血红蛋白更低（P<0.05）。ALN组中尿铁蛋白水平显著高于其他组[ALN 8.96 （4.15,22.74）vs ANR 1.51 （1.01,3.14）、非活动期SLE（INA）1.35 （0.70,3.10）、健康对照1.07 （0.55,1.42）;H=43.57,P<0.05）]。ALN组中尿KIM-1蛋白水平显著高于ANR组和健康对照组[ALN 87.96 （45.01,185.90）vs ANR 16.48 （4.91,29.26）、INA 9.62 （3.13,57.55）、健康对照9.78 （3.13,17.62）;H=48.65,P<0.05）]。尿铁蛋白、KIM-1蛋白水平均与蛋白尿呈正相关（相关系数=0.385、0.538,均P<0.05）。与有治疗反应组相比,无治疗反应组的血清肌酐、尿铁蛋白、KIM-1蛋白水平显著增加（P<0.05）。尿铁蛋白、KIM-1蛋白预测ALN治疗反应的AUC值分别为0.815（95%CI：0.675~0.955）、0.856（95%CI：0.731~0.981）。结论: 尿铁蛋白、KIM-1蛋白可能是预测LN治疗反应的一个有希望的候选生物标志物。
Abstract
Objective To analyze the value of iron metabolism related indexes in evaluating the condition and prognosis of lupus nephritis (LN). Methods This was a single-center, cross-sectional, observational cohort study in our hospital. The study time was from January 2021 to June 2022, and the subjects were 101 patients with systemic lupus erythematosus (SLE) and 11 healthy controls. Baseline urinary ferritin level and kidney injury molecule 1(KIM-1) protein level were compared between SLE patients and control group, and correlated with clinical features and subsequent treatment response. Results Compared with patients with active non-nephritis (ANR), patients with active lupus nephritis (ALN) were younger, with higher female ratio, proteinuria, rSLEDAI and SLEDAI and lower hemoglobin (P<0.05). The urinary ferritin level in ALN group was significantly higher than that in other groups [ALN 8.96(4.15, 22.74) vs ANR 1.51(1.01, 3.14), inactive SLE(INA) 1.35(0.70, 3.10) and healthy controls 1.07(0.55, 1.42); H=43.57, P<0.05) ]. The urinary KIM-1 protein level in ALN group was significantly higher than that in ANR group and healthy controls [AlN 87.96(45.01, 185.90) vs ANR 16.48(4.91, 29.26), INA 9.62(3.13, 57.55) and healthy controls 9.78(3.13, 17.62); H=48.65, P<0.05) ]. Urinary ferritin and KIM-1 protein levels were positively correlated with proteinuria (correlation coefficient =0.385, 0.538, both P<0.05). Compared with the group with treatment response, the levels of serum inosine, urinary ferritin and KIM-1 protein in the group without treatment response increased significantly (P<0.05). The AUC values of urinary ferritin and KIM-1 protein in predicting the therapeutic response of ALN were 0.815(95%CI: 0.675-0.955) and 0.856(95%CI: 0.731-0.981), respectively. Conclusion Urinary ferritin and KIM-1 protein may be a promising candidate biomarker for predicting the therapeutic response of LN.
关键词
狼疮性肾炎 /
尿液 /
铁蛋白 /
肾损伤分子1 /
治疗反应
Key words
lupus nephritis /
urine /
ferritin /
kidney injury molecule 1 /
therapeutic response
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基金
湖北省卫生健康委员会科研项目“铁代谢相关指标在评价狼疮病情和预后中的价值”（2020KH134）
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