狼疮性肾炎复发风险的中西医结合预测研究  

Disease Flare Patterns and Predictors of Lupus Nephritis Recurrence by Chinese and Western Medicine

作　　者：严小倩[1] 韩梅 刘琴[1] 鲁盈[1] YAN Xiao-qian;HAN Mei;LIU Qin;LU Ying(Department of Rheumatology,Tongde Hospital of Zhejiang Province,Hangzhou,310012)

机构地区：[1]浙江省立同德医院风湿科,杭州310012

出　　处：《中国中西医结合杂志》2019年第3期299-304,共6页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金资助项目(No.81673818);浙江省中医药管理局青年基金项目(No.2014ZQ007)

摘　　要：目的分析狼疮性肾炎(LN)患者中医证候积分、常规实验室指标以及尿血管细胞黏附因子-1(VCAM-1)、尿骨膜蛋白(Periostin)水平,寻找早期预测复发的风险因素。方法纳入在浙江省立同德医院门诊及病房的LN患者60例,其中30例处于活动期(设为活动组),30例处于缓解期(设为非活动组)。同时纳入20名健康志愿者作为对照组。对30例非活动组患者继续进行为期2年的随访观察,以8周为1次随访周期。记录中医证候积分、系统性红斑狼疮疾病活动度积分(SLEDAI)、英国狼疮评定组(BILAG)积分,ELISA法检测尿VCAM-1及尿Periostin水平,相关性检验采用Spearman相关性分析,根据是否出现肾脏活动绘制ROC曲线,分析VCAM-1和Periostin对肾脏复发的诊断效能,并找出其截断值。结果 (1)活动组患者尿VCAM-1及尿Periostin水平均高于非活动组(P<0.01),且非活动组高于对照组(P<0.01)。(2)尿VCAM-1与尿RBC、24 h尿蛋白定量、SLEDAI、BILAG积分、中医证候积分、ANA滴度呈正相关(P<0.05),与血ALB呈负相关(P<0.01)。尿Periostin与24 h尿蛋白定量、SCr、SLEDAI积分、BILAG积分及中医证候积分呈正相关(P<0.05),与血ALB呈负相关(P<0.01)。(3)根据尿VCAM-1的ROC曲线,其诊断狼疮肾炎疾病活动的特异性66.7%,敏感性96.7%。根据尿Periostin的ROC曲线,特异性36.7%,敏感性96.7%。(4)30例非活动组患者2年出现临床复发共13例(43.3%),临床复发前16、8周,尿VCAM-1及尿Periostin阳性比例明显高于未复发患者(P<0.05,P<0.01)。存在风湿内扰证候的患者更易出现肾脏疾病复发(P<0.01)。维持期服用羟氯喹及采用中西医结合治疗的患者更不易出现肾性复发(P<0.05)。结论尿VCAM-1及尿Periostin与狼疮肾炎疾病活动度密切相关并可早期预示LN肾性复发。风湿内扰证候与肾脏疾病复发密切相关。维持期服用羟氯喹及中药对预防复发具有一定作用。Objective To analyze the scores of Chinese medicine(CM) symptoms, laboratory indices, the level of urinary vascular cellular adhesion molecule-1(VCAM-1) and Periostin in patients with lupus nephritis(LN), and to investigate their potential feasibility to be the predictor for LN. Methods Patients with LN were recruited from the outpatient and inpatient services of Tongde hospital of Zhejiang Province, including 30 active patients(active group), 30 inactive patients(inactive group) and 20 normal controls(control group) at study entry. Thirty patients in the inactive group were followed up for a period of 2 years, once every 8 weeks. The scores of Chinese Medicine(CM) symptoms, The British Isles Lups Assessment Group(BLIAG), System Lups Erythematosus Disease Activity Index(SLEDAI) were recorded. Urinary VCAM-1 and Periostin levels were assessed cross-sectionally by ELISA. Correlation analyses were performed using the Spearman method. An ROC curve was constructed using the VCAM-1 and Periostin levels for each follow-up visit′s outcome of either the presence or absence of renal flare and find out their Cutoff value. Results(1)Compared with the inactive group, the levels of VCAM-1 and Periostin were higher in active group(P<0.01), and they were also higher in inactive group compared to the control group(P<0.01).(2)The level of VCAM-1 was positively correlated with the levels of hematuria, 24 hours urinary protein, ANA and the scores of CM symptoms,BLIAG, and SLEDAI(P<0.05), and it was also negatively correlated with blood albumin(P<0.01). The levels of Periostin was positively correlated with the levels of 24 hours urinary protein, serum creatinine and the scores of CM symptoms, BILAG and SLEDAI(P<0.05), and it was also negatively correlated with blood albumin(P<0.01).(3)According to the ROC curve, specificity of VCAM-1 was 66.7%, and the sensibility was 96.7%, the specificity of Periostin was 36.7%, and the sensibility was 96.7%.(4)In the longitudinal analysis, 13 patients(43.3%) had renal flare in the inactive grou

关 键 词：狼疮性肾炎 血管细胞黏附因子-1 骨膜蛋白 复发风险 

分 类 号：R593.242[医药卫生—内科学]