血清瘦素和脂联素联合检测在狼疮性肾炎诊断中的价值

doi:10.3969/j.issn.1673-8640.2019.05.004

摘要/Abstract

摘要：

目的探讨血清瘦素和脂联素联合检测在狼疮性肾炎（LN）诊断中的价值。方法选取84例女性系统性红斑狼疮（SLE）患者,并根据有无肾功能损伤分为LN组（38例）和非LN组（46例）。另选取45名体检健康女性,作为正常对照组。检测所有研究对象肌酐、白细胞计数和24 h定量尿蛋白水平,采用酶联免疫吸附试验对血清瘦素和脂联素进行检测。结果 LN组血清瘦素和脂联素水平分别为（34.12±21.41） ng/mL、（21.62±9.69） μg/mL,显著高于正常对照组[（17.21±16.43） ng/mL、（11.31±6.45）μg/mL]（P<0.05）。LN组脂联素水平也显著高于非LN组[（15.28±5.43）μg/mL]（P<0.05）。瘦素检测诊断LN的敏感性和特异性分别为63.16%、54.35%;脂联素检测诊断LN的敏感性和特异性分别为81.58%、28.26%。瘦素与脂联素联合检测诊断LN的敏感性和特异性分别为97.37%、19.57%。结论血清瘦素和脂联素联合检测对LN的诊断具有良好的敏感性,可为LN的早期诊断提供指导。

关键词: 瘦素, 脂联素, 狼疮性肾炎, 系统性红斑狼疮

Abstract:

Objective To investigate the role of serum adiponectin determination combined with leptin in the diagnosis of lupus nephritis （LN）. Methods A total of 84 female patients with systemic lupus erythematosus （SLE） were enrolled and classified into LN group （38 cases） and non-LN group （46 cases） according to be with or without renal damage. Totally,45 female healthy subjects were enrolled as healthy control group. Creatinine,white blood cell count and 24 h urinary protein were determined,and serum levels of leptin and adiponectin were determined by enzyme-linked immunosorbent assay. Results Serum levels of leptin and adiponectin in LN group were （34.12±21.41） ng/mL and （21.62±9.69） μg/mL,which were higher than those in healthy control group [（17.21±16.43） ng/mL and （11.31±6.45） μg/mL] （P<0.05）. Serum level of adiponectin in LN group was higher than that in non-LN group [（15.28±5.43） μg/mL] （P<0.05）. The sensitivity and specificity of leptin determination in the diagnosis of LN were 63.16% and 54.35%,respectively. The sensitivity and specificity of adiponectin in the diagnosis of LN were 81.58% and 28.26%,respectively. The sensitivity and specificity of the combined determination of leptin and adiponectin in the diagnosis of LN were 97.37% and 19.57%,respectively. Conclusions Serum adiponectin determination combined with leptin has high sensitivity in the diagnosis of LN,and it can provide a reference for the early diagnosis of LN.

Key words: Leptin, Adiponectin, Lupus nephritis, Systemic lupus erythematosus

中图分类号:

R446.1

徐黎明, 沈军. 血清瘦素和脂联素联合检测在狼疮性肾炎诊断中的价值[J]. 检验医学, 2019, 34(5): 401-404.

XU Liming, SHEN Jun. Role of serum adiponectin determination combined with leptin in the diagnosis of lupus nephritis[J]. Laboratory Medicine, 2019, 34(5): 401-404.

图/表 7

参考文献 16

[1]	DE ZUBIRIA SALGADO A,HERRERA-DIAZ C. Lupus nephritis:an overview of recent findings[J]. Autoimmune Dis,2012,2012:849684.
[2]	REKVIG O P,VAN DER VLAG J. The pathogenesis and diagnosis of systemic lupus erythematosus:still not resolved[J]. Semin Immunopathol,2014,36(3):301-311.
[3]	FAGGIONI R,FEINGOLD K R,GRUNFELD C.Leptin regulation of the immune response and the immunodeficiency of malnutrition[J]. FASEB J,2001,15(14):2565-2571.
[4]	FANTUZZI G.Adiponectin in inflammatory and immune-mediated diseases[J]. Cytokine,2013,64(1):1-10.
[5]	彭英兰,高锦团. 血清脂联素与尿蛋白在SLE患者体内的表达及意义[J]. 内蒙古医学杂志,2015,47(8):944-946.
[6]	王晓华,何杏容. 女性狼疮性肾炎患者血清IL-6及瘦素检测的意义[J]. 中国临床研究,2015,28(6):747-749.
[7]	张力奋,夏成云,权志慧,等. 血清瘦素和白细胞介素-6及肿瘤坏死因子-α水平与狼疮性肾炎的相关性研究[J]. 国际泌尿系统杂志,2015,35(6):915-919.
[8]	麻贞贞,孙红胜,杨清锐. 脂联素、内脂素、抵抗素在系统性红斑狼疮患者血清中的变化及临床意义[J]. 山东大学学报(医学版),2017,55(4):86-90.
[9]	石连杰,李春,朱佳鑫,等. 系统性红斑狼疮最新分类标准诞生[J]. 中华风湿病学杂志, 2012,16(10):713-714.
[10]	SCHWARTZ N,GOILAV B,PUTTERMAN C.The pathogenesis,diagnosis and treatment of lupus nephritis[J]. Curr Opin Rheumatol,2014,26(5):502-509.
[11]	MAROZ N,SEGAL M S.Lupus nephritis and end-stage kidney disease[J]. Am J Med Sci,2013,346(4):319-323.
[12]	MISRA R,GUPTA R.Biomarkers in lupus nephritis[J]. Int J Rheum Dis,2015,18(2):219-232.
[13]	TOUSSIROT E,STREIT G,WENDLING D.The contribution of adipose tissue and adipokines to inflammation in joint diseases[J]. Curr Med Chem,2007,14(10):1095-1100.
[14]	KRYSIAK R,HANDZLIK-ORLIK G,OKOPIEN B.The role of adipokines in connective tissue diseases[J]. Eur J Nutr,2012,51(5):513-528.
[15]	DIAZ-RIZO V,BONILLA-LARA D,GONZALEZ-LOPEZ L,et al.Serum levels of adiponectin and leptin as biomarkers of proteinuria in lupus nephritis[J]. PLoS One,2017,12(9):e0184056.
[16]	MAHIEU M A,AHN G E,CHMIEL J S,et al.Serum adipokine levels and associations with patient-reported fatigue in systemic lupus erythematosus[J]. Rheumatol Int,2018,38(6):1053-1061.

组别	例数	年龄（岁）	身高（cm）	体质量（kg）	心率（次/min）	收缩压（kPa）	体质量指数
LN组	38	33.93±12.15	164.21±5.22	59.13±6.19	73.21±4.33	11.75±0.67	23.67±3.39
非LN组	46	31.72±13.13	162.53±3.77	61.34±5.93	74.22±5.53	11.48±0.93	23.44±4.32
正常对照组	45	33.30±11.90	161.78±5.83	61.47±6.23	72.93±5.52	11.49±0.71	24.92±4.62
F值		0.009	0.059	0.043	0.017	0.033	0.037
P值		0.991	0.943	0.958	0.983	0.968	0.964

组别	例数	年龄（岁）	身高（cm）	体质量（kg）	心率（次/min）	收缩压（kPa）	体质量指数
LN组	38	33.93±12.15	164.21±5.22	59.13±6.19	73.21±4.33	11.75±0.67	23.67±3.39
非LN组	46	31.72±13.13	162.53±3.77	61.34±5.93	74.22±5.53	11.48±0.93	23.44±4.32
正常对照组	45	33.30±11.90	161.78±5.83	61.47±6.23	72.93±5.52	11.49±0.71	24.92±4.62
F值		0.009	0.059	0.043	0.017	0.033	0.037
P值		0.991	0.943	0.958	0.983	0.968	0.964

组别	例数	瘦素（ng/mL）	脂联素（μg/mL）	白细胞计数（×10⁹/L）	肌酐（μmol/L）	24 h定量尿蛋白（g）
LN组	38	34.12±21.41	21.62±9.69	2.11±0.41	470±120	5.34±1.74
非LN组	46	22.50±20.31	15.28±5.43	2.62±0.79	280±80	4.21±1.92
t值		1.089	2.631	4.494	1.859	1.474
P值		0.795	0.002	0.000	0.048	0.228

组别	例数	瘦素（ng/mL）	脂联素（μg/mL）	白细胞计数（×10⁹/L）	肌酐（μmol/L）	24 h定量尿蛋白（g）
LN组	38	34.12±21.41	21.62±9.69	2.11±0.41	470±120	5.34±1.74
非LN组	46	22.50±20.31	15.28±5.43	2.62±0.79	280±80	4.21±1.92
t值		1.089	2.631	4.494	1.859	1.474
P值		0.795	0.002	0.000	0.048	0.228

组别	例数	瘦素（ng/mL）	脂联素（μg/mL）	白细胞计数（×10⁹/L）	肌酐（μmol/L）	24 h定量尿蛋白（g）
LN组	38	34.12±21.41	21.62±9.69	2.11±0.41	470±120	5.34±1.74
正常对照组	45	17.21±16.43	11.31±6.45	6.33±0.87	110±20	0.71±0.23
t值		2.009	1.864	5.451	29.740	47.280
P值		0.018	0.047	0.000	0.000	0.000