补体组分1q和胱抑素C对狼疮性肾炎的实验室诊断  

Laboratory diagnosis of lupus nephritis by complement component 1q and cystatin C

作　　者：张亚梅 俸家富 Zhang Yamei;Feng Jiafu(Medicine Laboratory,Southwest Medical University;Department of Laboratory,The Affiliated Mianyang Central Hospital of Southwest Medical University)

机构地区：[1]西南医科大学检验科,泸州646000 [2]西南医科大学附属绵阳市中心医院检验科,绵阳621000

出　　处：《重庆医科大学学报》2019年第5期627-632,共6页Journal of Chongqing Medical University

基　　金：国家重点基础研究发展(973)计划子课题资助项目(编号:2015CB755400);四川省科技厅支撑项目资助项目(编号:2015SZ0117)

摘　　要：目的:探讨血清尿素(Urea)、肌酐(creatinine,Creat)、胱抑素 C(cystatin C,CysC)、估算肾小球滤过率(estimated glomerular filtration rate,eGFRCysC 与 c-aGFR)和补体组分 1q(component 1q,C1q)检测在狼疮性肾炎(lupus nephritis,LN)诊断中的应用价值。方法:选取 2017 年 3 月至 2017 年 12 月在绵阳市中心医院就诊的系统性红斑狼疮(systemic lupus erythematous,SLE)患者共 560 例,其中未累及肾脏患者 339 例(SLE 组),LN 活动期患者 150 例(LNA 组),LN 非活动期患者 71 例(LNI 组),另有360例健康个体作为对照(HC 组)。测定血清 Urea、Creat、Urea/Creat、CysC 和 C1q 水平,并计算 eGFRCysC 与 c-aGFR,以此评估这些指标对 LN 的诊断性能。结果:各观察指标在各组之间均有统计学差异(均 P=0.000)。 Spearman 相关性分析显示,C1q 与Creat(r=0.046,P=0.160)、Urea(r=0.011,P=0.748)、Urea/Creat(r=-0.011,P=0.743)无统计相关,与 CysC(r=-0.183,P=0.000)、eGFRCysC(r=-0.183,P=0.000)和 c-aGFR(r=-0.075,P=0.023)成负相关;CysC 与 Urea(r=0.309,P=0.000)和 Creat(r=0.382,P=0.000)成正相关,与 c-aGFR(r=-0.430,P=0.000)成负相关,与 Urea/Creat(r=0.003,P=0.927)不相关。受试者工作特征曲线(receiver operatingcharacteristic curve,ROC)分析显示,各观察指标单独对 LN 的诊断性能(area under curve,AUC)以 eGFRCysC(0.891)CysC(0.890)为最大,其后依次为:C1q(0.804)、Urea(0.660)、Urea/Creat(0.630)、c-aGFR(0.547)和 Creat(0.501)。C1q+CysC+c-aGFR 联合检测即可达到最大诊断性能(AUC=0.962),其敏感度为 89.3%,特异度为 93.1%,YI=0.824。增加检测指标,不能改善诊断性能。结论:单独检测时,以 CysC 或 eGFRCysC 对 LN 的诊断性能最高,其次为 C1q。联合检测以 C1q +CysC+c-aGFR 三项为最优,若出于经济考虑,C1q+CysC 联合检测也可达到相近于最优的诊断性能。Objective:To investigate the value of serum urea (Urea),creatinine(Creat),cystatin C(CysC),estimated glomerular filtration rate(eGFRCysC and c-aGFR),and complement component 1q(C1q) in the diagnosis of lupus nephritis(LN). Methods:A total of 560 patients with systemic lupus erythematous(SLE) who were admitted to our hospital from March to December,2017 were enrolled as subjects. In those patients,339 had the kidney uninvolved(SLE group),150 active LN(LNA group),and 71 inactive LN (LNI group). Additionally,360 healthy individuals were used as controls (HC group). Serum levels of Urea,Creat,Urea/Creat,CysC,and C1q were measured. eGFRCysC and c-aGFR were calculated to evaluate the diagnostic performance of these indices for LN. Results: There was a significant difference in each index between these groups(all P=0.000). Spearman correlation analysis showed that C1q was not correlated with Creat,Urea,or Urea/Creat(r=0.046,P=0.160;r=0.011,P=0.748;r=-0.011,P=0.743),but negatively correlated with CysC,eGFRCysC,and c-aGFR(r=-0.183,P=0.000;r=-0.183, P=0.000;r=-0.075,P=0.023). CysC was positively correlated with Urea and Creat (r=0.309,P=0.000;r=0.382,P=0.000), negatively correlated with c-aGFR(r=-0.430,P=0.000),but not correlated with Urea/Creat (r=0.003,P=0.927). The analysis of the diagnostic performance of individual index for LN by receiver operating characteristic curve revealed that eGFRCysC and CysC had the largest area under the curve(AUC=0.891,0.890),followed by C1q,Urea,Urea/Creat,c-aGFR,and Creat(AUC=0.804, 0.660,0.630,0.547,0.501). The maximum diagnostic performance was achieved by combined measurement of C1q,CysC,and c-aGFR,with a sensitivity of 89.3% and a specificity of 93.1%(AUC=0.962,YI=0.824). The diagnostic performance was not further im- proved by increasing the number of indices. Conclusion:For the diagnosis of LN by a single index,CysC or eGFRCysC has the best diagnostic performance,followed by C1q. For the diagnosis by multiple indices,C1q,CysC,and c-aGFR are the optimal combination. Combined measure

关 键 词：狼疮性肾炎 补体组分 1q 胱抑素 C 估算肾小球滤过率 肌酐 

分 类 号：R593.242[医药卫生—内科学]