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Abstract：
Renal involvement is an important cause of morbidity and mortality in systemic lupus erythematosus (SLE). The present study included patients with recently diagnosed Class III and Class IV lupus nephritis (LN) treated by Rheumatology who, upon the detection of alterations in their kidney function, were referred to Nephrology for the joint management of both medical specialties. The purpose of this study was to compare the plasma expression of Toll-Like Receptor 7 (TLR7) and TLR9 in healthy control (HC) subjects and newly diagnosed Class III and Class IV LN patients with 12-month follow-ups. The plasma expression of TLR7 and TLR9 proteins was determined by the ELISA method. A significant increase in the expression of TLR7 protein was found in Class III LN in the basal determination compared to the expression in the HC (p = 0.002) and at 12 months of follow-up (p = 0.03) vs. HC. The expression of TLR9 showed a behavior opposite to that of TLR7. TLR9 showed decreased protein expression in LN Class III patients\' baseline and final measurements. The result was similar in the basal and final determinations of LN Class IV compared to the expression in HC. A significant decrease in SLEDAI -2K was observed at 12 months of follow-up in patients in Class III (p = 0.01) and Class IV (p = 0.0001) of LN. Complement C3 levels improved significantly at 12-month follow-up in Class IV patients (p = 0.0001). Complement C4 levels decreased significantly at 12-month follow-up in LN Class III compared to baseline (p = 0.01). Anti-DNA antibodies decreased significantly at 12 months of follow-up in Class IV LN (p = 0.01). A significant increase in proteinuria was found at 12 months of follow-up in Class III LN, compared to the baseline determination (p = 0.02). In LN Class IV, proteinuria decreased at 12 months of follow-up compared to baseline (p = 0.0001). Albuminuria decreased at 12 months of follow-up in LN Class IV (p = 0.006). Class IV LN, albuminuria also decreased at 12 months of follow-up (p = 0.009). Hematuria persisted in all patients and the glomerular filtration rate did not change. Three Class IV patients died before 12 months of follow-up from various causes. In conclusion, although the rheumatologic data appeared to improve, the renal function data remained inconsistent. Decreased expression of TLR9 and increased expression of TLR7 could be useful in the early diagnosis of Class III and Class IV LN is correct.
摘要：
肾脏受累是系统性红斑狼疮（SLE）发病和死亡的重要原因。本研究包括最近诊断为III类和IV类狼疮性肾炎（LN）的患者，在检测到他们的肾功能改变后，因两个医学专业的联合管理而转诊至肾脏病学。这项研究的目的是比较健康对照（HC）受试者和新诊断的III类和IV类LN患者的Toll样受体7（TLR7）和TLR9的血浆表达，并进行12个月的随访。用ELISA法测定血浆TLR7和TLR9蛋白的表达。在基础测定中，与HC中的表达相比，在III类LN中发现TLR7蛋白的表达显着增加（p=0.002），在随访12个月时（p=0.03）与HC.TLR9的表达表现出与TLR7相反的行为。TLR9在LNIII类患者的基线和最终测量中显示蛋白质表达降低。与HC中的表达相比,IV类LN的基础和最终测定结果相似。在LN的III级（p=0.01）和IV级（p=0.0001）的患者随访12个月时，SLEDAI-2K显着降低。在随访12个月时，IV类患者的补体C3水平显着改善（p=0.0001）。与基线相比，LNIII级在12个月随访时补体C4水平显着下降（p=0.01）。在IV类LN中,抗DNA抗体在随访12个月时显著降低(p=0.01)。在III类LN随访12个月时发现蛋白尿显著增加，与基线测定相比（p=0.02）。在LN四级中，与基线相比,随访12个月时蛋白尿减少(p=0.0001).LNIV级随访12个月时，白蛋白尿减少（p=0.006）。IV类LN,随访12个月时,白蛋白尿也减少(p=0.009).所有患者均持续存在血尿，肾小球滤过率没有变化。3名IV级患者在随访12个月前因各种原因死亡。总之,虽然风湿病数据似乎有所改善，肾功能数据仍然不一致.TLR9的表达下调和TLR7的表达上调能够对III类和IV类LN的早期诊断是正确的。
