Change And Significance With IL-23/IL-17 In Peripheral Blood Of Patients With Idopathic Membranous Nephropathy

Background and Objective:Idiopathic membranous nephropathy(IMN)remains one of the most common causes of nephrotic syndrome(NS)in adults.However,the precise mechanisms involved in IMN have not been clear.Data from previous studies indicated that,IMN is an organ-specific autoimmune disease,and the formation of epithelial-side immune complexes is an antibody-mediated autoimmune response.CD4+T helper(Th)cell play important roles in regulation of autoimmunity in vivo.In the past,we have always thought that cytokines(IL-4,IL-10,etc.)secreted by Th2 cells stimulated B lymphocytes to produce immunoglobulin Ig G4 antibodies,which eventually led to the occurrence of IMN.Recently,studies have found that the percentage of Th17 cells in the peripheral blood of the experimental group is significantly higher than that of the healthy control group,confirming that the proliferation and activation of Th17 cells leads to the occurrence of IMN.IL-17 produced by Th17 cell differentiation is closely related to this process,and IL-23 plays an important role in inducing the differentiation and proliferation of IL-17.A large number of experiments have confirmed that the inflammatory response and the immune response caused by IL-17 in Th17 cells,that is,the IL-23 / IL-17 inflammation axis is considered to play a vital role in the occurrence and development of a variety of autoimmune diseases and kidney diseases.However,there are few studies on this inflammation axis in IMN.This study observes the changes of IL-23,IL-17 cytokines and related clinical indicators between the patients of IMN and healthy controls.After 6 months of treatment,they were divided into remission group and nonremission group.We will analyze the changes of the data before and after treatment in remission group and non-remission group.By observing and comparing the above data,describe the role of them in IMN.It also provides a reasonable application of tacrolimus in IMN,and provides new ideas for clinical treatment and assistance in understanding the patient's disease remission.Methods:1.Research object: The study patients were selected from the department of nephrology,the Huaihe Hospital of Henan University,from 2018 December to 2019 July,and diagnosed by renal biopsy in 30 cases of IMN patients(mean age 45.45 + 12.45 years old,male 13 and female 17).The patients of IMN treated by tacrolimus combined with glucocorticoid were followed up for 6 mouths.During the same period,20 healthy physical examination volunteers(including 7 males and 13 females,mean age 51.30 + 12.42 years old)were selected from the Health Examination Center of Huaihe Hospital of Henan University.2.Grouping: All subjects were divided into healthy control group(Group A)and idiopathic membranous nephropathy group(Group B).After 6 months of treatment,compared the serum of IL-23?IL-17?24-hour urine protein quantification,total cholesterol,triglycerides,etc.between remission(Group C)and non-remission(Group D)groups before and after treatment.Enzyme-linked immunosorbent assay was used to test serum IL-17 and IL-23 concentration.Patients' names,gender,age,24-hour urine protein,serum creatinine(Scr),blood lipid,albumin(ALB)and other indicators were collected for correlation analysis.Results:(1)Before treatment(T0),IL-17,IL-23,24-hour urine protein quantitation,total cholesterol,triglyceride levels were significantly higher in group B than group A,the difference was statistically significant(P <0.05);The plasma albumin level was lower than that in group A,and the difference was statistically significant(P<0.05);there was no statistical difference between the two groups in age and gender(P> 0.05).(2)Before treatment,IL-17 were positively correlated with 24-hour urine protein?Total cholesterol?Triglyceride?albumin(r=0.722?r=0.533?r=415)and were inversely correlated with plasma albumin(ALB)(r=-0.690);the level of serum IL-23 was uncorrelated with the clinical various indicators:24-hour urine protein?albumin(ALB)?Total cholesterol?Triglyceride(r=0.305?r=-0.305?r=0.330?r=0.236).(3)Serum IL-23 was positively correlated with IL-17 in the A group and B group.(r=0.716,r=0.637).(4)Serum IL-23? IL-17 and the interaction factors between IL-23 and IL-17 are positively correlated with the IMN.(5)After 6 mouths of follow-up,IL-17?IL-23?24-hour urine protein?Total cholesterol?Triglyceride decreased and albumin gradually increased significantly compared with before treatment in IMN group.At 3 mouth and 6 mouth,the differences were statistically significant(P<0.05).(6)Patients of IMN were divided into two groups on the response to therapy after 6 mouths.Before and after treatment,data showed that patients whose symptoms persist had a higher level of IL-17 and IL-23 than those who had a good response to treatment.Conclusion:1.In IMN group,the level of serum IL-17 gradually decreased with the remission of the disease;IL-17 were positively correlated with 24-hour urine protein and inversely correlated with albumin(ALB).Suggesting that IL-17 might be involved in the pathogenesis of IMN and the level of IL-17 indicated severity of the disease.2.Serum IL-23? IL-17 and the interaction factors between IL-23 and IL-17 were positively correlated with the IMN.Serum IL-23 was positively correlated with IL-17 and uncorrelated with the clinical various indicators:24-hour urine protein?albumin(ALB)?Total cholesterol?Triglyceride,suggesting that IL-23 participated in the occurrence and development of IMN by promoting IL-17 secretion.3.The IL-17 level in the remission group was significantly lower than that in the non-remission group before and after treatment.The level of IL-17 might indicate the effect of drug treatment.