Changes Of Serum ANCA In Different TCM Syndromes Of ANCA-associated Small Vasculitis Renal Failure And Its Correlation With Urine IL-18

Objective:To observe the changes of serum ANCA in different TCM syndromes of patients with ANCA-associated vasculitis(AASV)renal impairment.We detected the level of interleukin-18(IL-18)in urine of AASV patients with renal damage,and analyze the relationship between urinary IL-18 levels and other laboratory markers including ANCA in these patients.So that we can explore the significance of IL-18 in AASV renal damage.Methods:This is a retrospective study of patients diagnosed with AASV renal impairment from December 2012 to July 2016,in which we collected the clinical information of patients and analyzed the relationship between TCM syndrome of AASV renal damage and clinic presentation as well as laboratory examination.Besides,outpatients or inpatients diagnosed with AASV renal impairment in Fuzhou General Hospital between July 2015 and July 2016 are included in the study.By collecting related clinical date,taking patients'urine,and evaluating the level of IL-18 in urine through enzyme linked immunosorbent assay(ELIS A),we analyzed the association between urinary IL-18 levels and other laboratory markers in patients with AASV renal impairment.All data analysis was done using SPSS20.0 software packages.Results:1.Among the 125 AASV patients selected,118 patients presented anemia(94.4%).There were 105 cases(84.0%)of hematuria,112 cases(89.6%)of proteinuria,114 cases(91.2%)of renal function deterioration,and 52 cases(41.6%)for renal replacement therapy.99(79.2%)cases had lung involvement,102 cases(81.6%)had gstrointestinal symptoms.2.Accroding to the retrieval results of documents and the characteristics of TCM syndrome in patients,we established asthenia of pulmonosplenic qi(PSQA),endoretention of damp heat(EDH),qi-yin deficiency(QYD)and deficiency of both spleen and kidney(SKD)as AASV main syndrome types,all syndrome types had no differences in sex ratio and age of oneset.3.Different syndrome types had differences in disease stage,patients of EDH and SKD were in active stage more than in remission stage significantly(P<0.05);These syndrome types had differences in onset ways else,the onset way of EDH tended to be AKI,while SKD and QYD more likely to present CKD onset(P<0.05).4.The level of MPO-ANCA,24h urinary protein quantification,CysC and ACR in QYD was less than in EDH,PSQA and SKD,which's GFR was higher than after three significantly(P<0.05).The level of 24h urinary protein quantification in EDH was higher than in SKD,the difference was in statistical significance.It's significant that the level of ?2-MG in EDH was higher than in PSQA and QYD.5.Urinary IL-18 in AASV patients was positively correlated with ANCA and BVAS scores(P<0.05).6.The levels of urinary?2-MG,ACR,ANCA,BVAS scores and urinary IL-18 in the active AASV group were significantly higher than those in the inactive AASV group(P<0.05).But the levels of ALB,GFR in the active group were lower than those in the inactive group(P<0.05).7.Urinary IL-18 levels in EDH and SKD were higher than in PSQA and QYD(P<0.05).Conclusion:1.The clinic presentation of ANCA-associated vasculitis more likely to be multiple organ involvement,which is particularly common in kidney involvement.2.There is a change of ANCA in different TCM syndromes of patients with AASV renal impairment,ANCA in QYD is lowest,while GFR in QYD is highest,which indicates QYD is more common in patients with mild vasculitis.3.Urinary IL-18 in the AASV active group were higher than those in the AASV inactive group,IL-18 may paticipate in the pathogenesis of AASV.4.Urinary IL-18 in AASV patients was positively correlated with ANCA and BVAS scores.5.The increase of urinary IL-18 levels are more common in AASV patients who are diagnosed with EDH and SKD syndromes.