| Objective:Detect the expression levels of B cell activating factor belonging to th e TNF family(BAFF)?Aproliferation-inducing ligand(APRIL)?Toll-like receptors 9(TLR9)in peripheral blood serum of patients with IgA nephropathy,explore the c orrelation between these three cytokines with the pathological severity,clinical ind icators and explore the correlation between these three cytokines,so as to provide clues for further revealing the mechanism of the development of IgA nephropath y and exploring their clinical application value.Methods:78 patients with pathologically confirmed primary IgA nephropathy by r enal biopsy were included in the study.According to Lee's classification,patients with IgA nephropathy were divided into two groups:patients with Lee's classificat ion of I-III were group 1,patients with Lee's classification of IV-V were group 2.According to Oxford's classification,patients were divided into S0/S1,E0/E1,T0/1/2,C0/1/2.Eight healthy and age-matched volunteers were served as the control g roup.All patients and volunteers signed informed consent.The expression levels of BAFF,APRIL,TLR9 were detected by human serum enzyme-linked immunosorb ent assay(ELISA)kit.The Mann-Whitney U test and Spearman rank correlation w ere used to compare the expression levels of BAFF,APRIL,and TLR9 between different pathological groups.The multi-factor correlation analysis of generalized e stimation equation was used to analyze the correlation between the expression lev els of the three factors and clinically relevant indicators.A simple linear regressio n analysis was used to analyze the correlation between the three cytokines,P<0.05 was considered statistically significant.Results:The expression levels of BAFF in the peripheral blood serum of the dise ased group was higher than that of the healthy group[769.6(402.35)ng/ml vs.846.05(181.24)ng/ml,P<0.05];The expression levels of APRIL in the peripheral bl ood serum of the diseased group was higher than that of the healthy group[10.97(4.01)ng/ml vs.14.11(3.18)ng/ml,P<0.05];The expression levels of TLR9 in t he peripheral blood serum of the diseased group was higher than that of the healt hy group[20.25(5.19)ng/ml vs.24.88(5.87)ng/ml,P<0.05].According to Lee's cl assification,the expression levels of BAFF in patients'peripheral blood serum incre ased with the severity of the disease pathology[769.6(402.35)ng/ml vs.811.80(176.35)ng/ml vs.861.20(267.05)ng/ml,P<0.05];the expression levels of ARRIL i n patients'peripheral blood serum increased with the severity of the disease patho logy,but the difference was not statistically significant[10.97(4.01)ng/ml vs.14.15(2.77)ng/ml vs.14.07(4.13)ng/ml,P>0.05];the expression levels of TLR9 in patients'peripheral blood serum increased with the severity of the disease patholo gy[20.25(5.19)ng/ml vs.24.27(5.01)ng/ml vs.25.49(7.62)ng/ml,P<0.05].(2)T he expression levels of APRIL in the peripheral blood serum in group E1 were h igher than those in group E0[15.042(2.975)ng/ml vs.13.997(3.314)ng/ml,P=0.03].Tthe differences were not statistically significant between the comparison of th e three factors'expression levels in other Oxford grades.(3)The expression levels of BAFF,APRIL and TLR9 in the serum of patients with IgA nephropathy were not significantly correlated with the disease-related indicators such as urinary prot ein quantification of one day,serum creatinine level,eGFR,hypertension,gender and age(P>0.05);(4)There was a positive correlation between the expression lev els of BAFF in peripheral blood of patients with IgA nephropathywith those of A PRIL(R2=0.973,P<0.001,Y=74.124+53.630X);There was a positive correlation b etween the expression levels of APRIL in peripheral blood of patients with IgA n ephropathywith those of TLR9(R2=0.951,P<0.001,Y=-5.790+0.810X);There was a positive correlation between the expression levels of BAFF in peripheral blood of patients with IgA nephropathywith those of TLR9(R~2=0.963,P<0.001,Y=-266.693+44.350X).Conclusion:(1)Combining the two pathological grading methods of IgA nephropat hy(Lee's pathological grade and Oxford grade),it is concluded that both patholog ical grade can respectively explain the severity of the disease in patients with IgA nephropathy,but in tubule atrophy/interstitial fibrosis and the crescent,the chang es are common.The patients whose severity of the disease are heavier in the Lee's pathological grade also have heavier changes in tubule atrophy/interstitial fibrosi s of the Oxford grade.(2)The expression levels of BAFF,TLR9 and APRIL were increased in peripheral blood serum of IgA nephropathy patients.The expression le vels of BAFF,TLR9 and APRIL were positively correlated with the pathological severity of the disease.The three factors may reflect the severity of IgA nephropa thy and are expected to be important predictors of the prognosis of IgA nephropa thy.(3)The expression levels of BAFF,TLR9 and APRIL in the peripheral blood s erum were not closely related to clinically relevant indicators of patients with IgA nephropathy.(4)The expression levels of BAFF,TLR9 and APRIL in peripheral blood serum of IgA nephropathy patients were positively correlated with each ot her.They may be associated with each other and promote each other in the proce ss of disease development,and participate in the occurrence and development of I gA nephropathy.(5)We speculate that TLR9 may cause abnormal B cell proliferati on and abnormally similar transform which will lead to IgA nephropathy by up r egulating the expression of BAFF and APRIL and the BAFF/APRIL ligand recept or system. |
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