■在特发性膜性肾病(iMN)患者中观察到高血清水平的B细胞活化因子(BAFF)和增殖诱导配体(APRIL);然而,它们与疾病严重程度和进展的关系尚不清楚.
■通过肾活检诊断为iMN的患者纳入本研究。使用ELISA试剂盒测定BAFF和APRIL的浓度。蛋白尿缓解,包括完全缓解(CR)和部分缓解(PR),肾功能恶化定义为临床事件.采用Cox比例风险法分析细胞因子水平与疾病进展的关系。
■本研究纳入了70例iMN患者,中位随访时间为24个月(6-72个月)。iMN患者的血清BAFF和APRIL水平高于健康对照组,但低于微小病变(MCD)患者。血清BAFF水平与血清APRIL水平呈正相关,血清抗磷脂酶A2受体(抗PLA2R)抗体水平,24h蛋白尿,与血清白蛋白(ALB)水平呈负相关。然而,血清APRIL水平与临床参数之间没有显着相关性。根据性别调整后的多变量Cox比例风险回归模型,年龄,收缩压(SBP),估计肾小球滤过率(eGFR),使用免疫抑制剂,24小时蛋白尿,4月级别,和抗PLA2R抗体,只有血清BAFF水平被确定为PR的独立预测因子(HR,0.613;95%CI,0.405-0.927;p=0.021)和蛋白尿的CR(HR,0.362;95%CI,0.202-0.648;p<0.001)。
■高血清BAFF水平与iMN患者的严重临床表现和不良疾病进展相关。
UNASSIGNED: High serum levels of B-cell activation factor (BAFF) and a proliferation-inducing ligand (APRIL) have been observed in patients with idiopathic membranous nephropathy (iMN); however, their relationships with disease severity and progression remain unclear.
UNASSIGNED: Patients with iMN diagnosed via renal biopsy were enrolled in this study. The concentrations of BAFF and APRIL were determined using ELISA kits. Proteinuria remission, including complete remission (CR) and partial remission (PR), and renal function deterioration were defined as clinical events. The Cox proportional hazards method was used to analyze the relationship between cytokine levels and disease progression.
UNASSIGNED: Seventy iMN patients were enrolled in this study, with a median follow-up time of 24 months (range 6-72 months). The serum levels of BAFF and APRIL were higher in iMN patients than in healthy controls but lower than those in minimal change disease (MCD) patients. The serum BAFF level was positively correlated with the serum APRIL level, serum anti-phospholipase A2 receptor (anti-PLA2R) antibody level, and 24-h proteinuria and negatively correlated with the serum albumin (ALB) level. However, no significant correlation was observed between the serum APRIL level and clinical parameters. According to the multivariate Cox proportional hazards regression model adjusted for sex, age, systolic blood pressure (SBP), estimated glomerular filtration rate (eGFR), immunosuppressive agent use, 24-h proteinuria, APRIL level, and anti-PLA2R antibody, only the serum BAFF level was identified as an independent predictor of PR (HR, 0.613; 95% CI, 0.405-0.927; p = 0.021) and CR of proteinuria (HR, 0.362; 95% CI, 0.202-0.648; p < 0.001).
UNASSIGNED: A high serum BAFF level is associated with severe clinical manifestations and poor disease progression in patients with iMN.