系统性红斑狼疮两种评分系统对狼疮肾炎活动临床评价的比较  

The comparison of two systemic lupus erythematosus scoring systems for assessing lupus nephritis activity

作　　者：王蒙[1] 韩迪迪 王力宁[1] 周华[1] 范秋灵[1] 刘林林[1] 杨爽[1] 王娟[1] 刘楠[1] 孙达[1] 

机构地区：[1]中国医科大学附属第一医院肾内科,沈阳110001

出　　处：《中华风湿病学杂志》2016年第6期391-395,I0001,共6页Chinese Journal of Rheumatology

基　　金：十二五国家科技支撑计划（2011BAI10804）

摘　　要：目的比较SLEDAI与英国狼疮评估组（BILAG）2种评分系统评价LN患者的疾病活动状况及临床意义。方法收集136例SLE合并LN患者的临床资料，采用SLEDAI-2000与Classic BILAG评分评价疾病活动度。应用Spearman相关分析及Pearson相关分析比较2种方法与各项生化学指标、免疫学指标及肾脏病理改变的相关性，绘制受试者工作曲线（ROC曲线）评价2种评分系统。结果2种评分与尿红细胞计数、尿蛋白定量（24 h）呈正相关（BILAG：r=0.306、0.305，P〈0.01；SLEDAI：r=0.245、0.303，P〈0.01）；与血红蛋白、血小板、抗U1核糖核蛋白（U1RNP）抗体、补体C3呈负相关（BILAG：r=-0.499、-0.311、-0.230、-0.324，P〈0.01；SLEDAI：-0.299、-0.328、-0.210、-0.399，P〈0.01）；Classic BILAG评分与抗dsDNA抗体不相关，SLEDAI-2000评分与抗dsDNA抗体呈正相关（r=0.415，P〈0.01）；Classic BILAG评分与活动指数（AI）、慢性指数（CI）、肾小管间质损害（TIL）呈正相关性（r=0.506，P〈0.01；r=0.218，P〈0.05；r=0.336，P〈0.01）。SLEDAI-2000评分仅与AI呈正相关（r=0.492，P〈0.01），与CI、TIL不相关；2种评分系统结果有差异时，Classic BILAG分级低者与SLEDAI-2000评分低者尿蛋白定量（24 h）分别为（0.25±0.17）g、（2.05±2.33）g（P〈0.05），AI分别为1.4±0.5、3.8±2.2（P〈0.05）；Classic BILAG曲线下面积（AUC）为0.748，SLEDAI-2000 AUC为0.693。结论SLEDAI评分系统与BILAG评分系统均可用于评价LN患者SLE活动状态，但BILAG评分系统与SLE患者肾脏损害密切相关，为临床LN患者治疗方案的制定及调整提供依据。Objective To compare the activity status and clinical significance between systemic lupus erythematosus disease activity index （SLEDAI） and British Isles lupus assessment group（BILAG） scoring systems for assessing disease activity in patients with lupus nephritis （LN）.Methods The clinical data of 136 patients with lupus nephritis were collected, SLEDAI-2000 and Classic BILAG scoring systems were used to assess disease activity. The correlations between these two scoring systems and biochemical parameters, immunological indicators, renal pathological index were analyzed using Pearson correlation test and Spear-man＇s rank correlation coefficient test. The two scoring systems were evaluated using ROC curve.Results The two scoring systems were all positively correlated with urinary red blood cells, 24-hour urinary protein level （BILAG： r=0.306, 0.305, P〈0.01; SLEDAI： r=0.245, 0.303, P〈0.01）; and negatively correlated with hemoglobin, blood plateletcounts, anti-U1RNP antibodies, complement C3 level （BILAG： r=-0.499, -0.311, -0.230,-0.324, P〈0.01; SLEDAI： -0.299, -0.328, -0.210, -0.399, P〈0.01）. Classic BILAG scoring system was not correlated with anti-double-stranded DNA （dsDNA） antibodies, but SLEDAI-2000 scoring system was positively correlated with anti-dsDNA antibodies（r=0.415, P〈0.01）. Classic BILAG scoring system was positively correlated with pathology activity index （AI）, chronic index （CI）, tubule-interstitial lesions （TIL） （r=0.506,P〈0.01; r=0.218, P〈0.05; r=0.336, P〈0.01）. SLEDAI-2000 scoring system was only positively correlated with AI （r=0.492, P〈0.01）, not correlated with CI, TIL; When these two scoring systems led to different results, the 24-hour urinary protein of patients with low activity on Classic BILAG and patients with low SLEDAI-2000 score were （0.25±0.17） g, （2.05±2.33） g （P〈0.05）, AI were 1.4±0.5, 3.8±2.2 （P〈0.05）; The Classic BILAG scoring system had an area under the ROC curve（AUC） of 0.

关 键 词：红斑狼疮 系统性 狼疮肾炎 系统性红斑狼疮疾病活动指数评分 英国狼疮评估组评分 

分 类 号：R593.24[医药卫生—内科学]