CAJ | 학술논문

也页目的：探讨尿白细胞介素-17(IL-17)检测对评估IgA肾病(IgAN)病情严重程度和治疗疗效中的价值。方法：应用酶联免疫吸附法( ELISA)检测79例原发性IgAN患者治疗前后的尿IL-17水平,分析患者治疗前尿IL-17水平与临床指标、牛津病理分型[系膜细胞增生( M)、内皮细胞增生( E)、节段硬化或黏连( S)和肾小管萎缩/间质纤维化( T)]的相关性；比较不同治疗方案下患者治疗前后尿IL-17水平的变化以及与疾病转归的关系。结果：IgAN患者治疗前尿IL-17的水平较正常对照显著升高并且与尿中性粒细胞明胶酶相关脂质运载蛋白( NGAL)的水平和24 h尿蛋白呈正相关、与eGFR呈负相关。根据牛津病理分型,E1组患者的尿IL-17水平显著高于E0组,T1组和T2组患者的尿IL-17水平分别显著高于T0组,M0组与M1组、S0组与S1组、T1组与T2组的尿IL-17水平差异均无统计学意义。治疗6个月后,在单用血管紧张素转换酶抑制剂( ACEI)治疗的患者中治疗显效组的尿IL-17水平较治疗前显著下降,而治疗无效组的尿IL-17水平较治疗前无显著下降；ACEI联合糖皮质激素治疗的患者中治疗有效组和无效组在治疗后的尿IL-17水平较治疗前均显著下降。结论：尿IL-17水平在评估IgAN患者的病情和疗效预判方面具有潜在的临床实用价值。
야혈목적：탐토뇨백세포개소-17(IL-17)검측대평고IgA신병(IgAN)병정엄중정도화치료료효중적개치。방법：응용매련면역흡부법( ELISA)검측79례원발성IgAN환자치료전후적뇨IL-17수평,분석환자치료전뇨IL-17수평여림상지표、우진병리분형[계막세포증생( M)、내피세포증생( E)、절단경화혹점련( S)화신소관위축/간질섬유화( T)]적상관성；비교불동치료방안하환자치료전후뇨IL-17수평적변화이급여질병전귀적관계。결과：IgAN환자치료전뇨IL-17적수평교정상대조현저승고병차여뇨중성립세포명효매상관지질운재단백( NGAL)적수평화24 h뇨단백정정상관、여eGFR정부상관。근거우진병리분형,E1조환자적뇨IL-17수평현저고우E0조,T1조화T2조환자적뇨IL-17수평분별현저고우T0조,M0조여M1조、S0조여S1조、T1조여T2조적뇨IL-17수평차이균무통계학의의。치료6개월후,재단용혈관긴장소전환매억제제( ACEI)치료적환자중치료현효조적뇨IL-17수평교치료전현저하강,이치료무효조적뇨IL-17수평교치료전무현저하강；ACEI연합당피질격소치료적환자중치료유효조화무효조재치료후적뇨IL-17수평교치료전균현저하강。결론：뇨IL-17수평재평고IgAN환자적병정화료효예판방면구유잠재적림상실용개치。
Objective:To evaluate the level of urine IL-17 in IgAN patients and its significance in reflecting disease activi-ty and treatment efficacy. Methods:Urine IL-17 levels of 79 patients with biopsy-proven IgAN before and after treatment ( ACEI with or without corticosteroids) were measured by enzyme-linked immunosorbent assay (ELISA). The correlation between pre-treatment urine IL-17 levels and clinical/renal pathological parameters were analyzed; The difference of urine IL-17 levels before and after treatment were compared in two groups of IgAN patients with different treatments. Results:Before treatment, urine IL-17 levels of IgAN patients were significantly elevated compared with normal controls and urine IL-17 levels were significantly correlated with urine level of neutrophil gelatinase-associated lipocalin ( NGAL) , 24 h proteinuria and eGFR. Using the Oxford classification system, we found that urine IL-17 levels of those patients with E1 were significantly higher than those with E0, and urine IL-17 levels of those patients with T1 and T2 were respectively higher than those with T0. After 6 months of treatment, in patients only trea-ted with ACEI, post-treatment urine IL-17 levels in patients with complete or partial remission were significantly lower compared with pre-treatment levels, while urine IL-17 levels in patients who didn't respond to ACEI didn't change significantly before and after treatment;However, in patients treated with ACEI and corticosteroids, post-treatment urine IL-17 levels of both remission and treatment-resistant patient groups were significantly lower compared with pre-treatment levels. Conclusion:Urine IL-17 level is a useful biological marker for the assessment of disease severity and treatment efficacy of IgAN patients.