血清B细胞活化因子水平对狼疮肾炎患儿疾病活动度及预后的评估价值  

The Evaluated Value of the Serum B-Cell Activating Factor to the Disease Activity and Prognosis in Children with Lupus Nephritis

作　　者：谢海清[1] 朱玲珍 覃嫏颖 吉初灵 李立佳 XIE Haiqing;ZHU Lingzhen;QIN Langying;JI Chuling;LI Lijia(Department of Pediatrics,the First Affiliated Hospital of Hainan Medical College,Haikou 570102,China)

机构地区：[1]海南医学院第一附属医院儿科,海南海口570102

出　　处：《标记免疫分析与临床》2020年第9期1578-1582,1636,共6页Labeled Immunoassays and Clinical Medicine

基　　金：海南省教育厅科研项目(编号:hnky2015-41)。

摘　　要：目的探讨血清B细胞活化因子(sBAFF)与狼疮肾炎(LN)患儿疾病活动度的相关性,评估血清BAFF水平对患儿预后结局的判断价值。方法选择68例本院住院治疗的LN患儿,根据患儿狼疮疾病活动性计分(SLEDAI)差异分为:轻中度组,共38例;重度组,共30例。选取同时期儿童保健科门诊体检的健康儿童40例为对照组。检测比较3组外周血检测sBAFF、抗双链DNA抗体(抗ds-DNA)、C3、丙氨酸转氨酶(ALT)、白细胞计数(WBC)的差异;评估并比较3组(SLEDAI、24 h尿蛋白定量、尿β2微球蛋白(β2-MG)的差异。采用Pearson相关分析评估sBAFF值与临床指标的相关性。随访2年,根据预后情况分为:缓解组,44例;未缓解组,24例。比较两组sBAFF及SLEDAI评分。应用多元Logistic回归分析与随访2年LN患儿预后相关的危险因素。绘制受试者工作特征曲线(ROC)评估sBAFF对随访2年LN患儿预后的评估价值。结果重度组患儿血清sBAFF、抗ds-DNA、ALT以及24 h尿蛋白定量、尿β2-MG、SLEDAI显著高于轻中度组,且两组均高于对照组(均P<0.05);但重度组患儿C3及WBC显著低于轻中度组,且两组均低于对照组(均P<0.05)。Pearson相关分析显示LN患儿血清sBAFF分别与SLEDAI评分、抗ds-DNA呈正相关(r=0.847,P=0.012、r=0.713,P=0.030),而与C3呈负相关(r=-0.636,P=0.039)。未缓解组sBAFF及SLEDAI评分均高于缓解组(均P<0.05)。多元Logistic回归分析显示,sBAFF为随访2年LN患儿预后相关的危险因素(OR=3.219,P=0.011)。ROC曲线显示,血清sBAFF截断值为858.5 pg/mL,预测LN患儿随访2年预后不良的AUC为0.836,灵敏度为88.2%,特异性为79.4%,诊断准确度优于SLEDAI评分(P=0.041)。结论血清sBAFF与LN患儿疾病活动度正相关,且sBAFF评估随访2年LN患儿预后结局的准确度较好。Objective To analyze the clinical value of the serum B-cell activating factor(sBAFF)to the disease activity and prognosis in children with lupus nephritis(LN).Methods 68 children with LN in our hospital were collected for the study.All children were divided into two groups according to the degree of ill condition,which were the mild-moderate group(38 cases)and severe group(30 cases).The contemporaneous 40 healthy children in the utpatient department of pediatric health care were selected as the control group.The serum levels of sBAFF,anti-distrand-DNA antibody(anti ds-DNA),C3,alanine aminotransferase(ALT)and the number of WBC were detected and compared among three groups.The indexes of systemic lupus erythematosus disease activity score(SLEDAI),24 h urinary protein quantity and urineβ2 microglobulin(β2-MG)were detected and compared among three groups.The correlation of the levels of sBAFF to clinical indexes were analyzed by Pearson correlation analysis.After 2 years of follow-up,all children with LN were divided into two groups according to the prognosis,which were the remission group(44 cases)and non-response group(24 cases).The levels of sBAFF and SLEDAI were compared between those two groups.The risk factors of 2-years follow-up prognosis of children with LN to the clinical indexes were confirmed by multivariate Logistic analysis.The diagnostic value of the levels of sBAFF to the 2-years follow-up prognosis of the children with LN were analyzed by receiver operating characteristic curves(ROC).Results The indexes of sBAFF,anti-ds-DNA,ALT,24h urinary protein quantity,β2-MG and SLEDAI in the severe group were highest,and the above indexes in the mild-moderate group were the second highest,and the control group were the lowest(all P<0.05).The indexes of C3 and WBC in the severe group were the lowest,and the above indexes in the mild-moderate group were the second lowest,and the control group were the highest(all P<0.05).The positive correlation of sBAFF to SLEDAI(r=0.847,P=0.0120)and anti-ds-DNA(r=0.713,P=0.03

关 键 词：狼疮肾炎 B细胞活化因子 预后 ROC曲线 

分 类 号：R593.242[医药卫生—内科学]