血清补体C5a水平和红细胞沉降率与系统性红斑狼疮疾病活动度及预后的关系  

Correlations of serum complement C5aand erythrocyte sedimentation rate with disease activity and prognosis in patients with systemic lupus erythematosus

作　　者：庞杰 张宗芳 李艳霞 杨雯雯 许化恒[1] 陶然 崔欣 左艳华 PANG Jie;ZHANG Zongfang;LI Yanxia;YANG Wenwen;XU Huaheng;TAO Ran;CUI Xin;ZUO Yanhua(Department of Rheumatology and Immunology,Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市中心医院风湿免疫科,河北沧州061000

出　　处：《中华实用诊断与治疗杂志》2020年第11期1110-1113,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河北省医学科学研究课题(20200323)。

摘　　要：目的分析系统性红斑狼疮(systemic lupus erythematosus,SLE)患者血清补体C5a水平、红细胞沉降率(erythrocyte sedimentation rate,ESR)与SLE疾病活动度及预后的关系,探讨补体C5a、ESR在SLE患者预后评估中的应用价值。方法SLE患者198例为SLE组,同期体检健康者60例为对照组。SLE组根据SLE活动性指数(systemic lupus erythematosus disease activity index,SLEDAI)评分分为无活动组67例,轻度活动组54例,中度活动组41例,重度活动组36例;根据治疗后12个月疗效分为临床缓解组137例和预后不良组61例。比较治疗前、后各组血清补体C5a水平、ESR;Pearson相关法分析SLE患者血清补体C5a、ESR与SLEDAI评分的相关性;绘制ROC曲线评价血清补体C5a联合ESR评估SLE患者预后的效能。结果SLE组治疗前血清补体C5a水平[(95.61±16.04)ng/L]、ESR[(51.22±6.37)mm/h]高于对照组[(23.94±15.32)ng/L、(13.86±5.92)mm/h](P<0.05)。血清补体C5a水平、ESR在无活动组[(31.34±14.20)ng/L、(23.86±5.72)mm/h]、轻度活动组[(68.55±13.63)ng/L、(41.22±5.95)mm/h]、中度活动组[(93.16±12.24)ng/L、(64.57±5.23)mm/h]、重度活动组[(127.58±13.75)ng/L、(91.34±6.49)mm/h]依次升高(P<0.05)。SLE患者血清补体C5a水平、ESR与SLEDAI评分呈正相关(r=0.745,P<0.001;r=0.693,P<0.001)。预后不良组血清补体C5a[(97.24±18.13)ng/L]、ESR[(62.38±7.55)mm/h]高于临床缓解组[(45.19±16.57)ng/L、(27.04±6.92)mm/h](P<0.05)。血清补体C5a以73.59ng/L为最佳截断值,预测SLE患者预后不良的AUC为0.843(95%CI:0.787~0.900,P<0.001),灵敏度为80.33%,特异度为81.75;ESR以51.02mm/h为最佳截断值,预测SLE患者预后不良的AUC为0.777(95%CI:0.707~0.849,P<0.001),灵敏度为70.49%,特异度为76.64%;二者联合预测SLE患者预后不良的AUC为0.928(95%CI:0.889~0.967),灵敏度为90.16%,特异度为91.97%;联合检测的AUC、灵敏度、特异度均高于单独检测(P<0.05)。结论SLE患者血清补体C5a水平、ESR升高,且增高程度与SLE疾病活动�Objective To analyze the correlations of serum complement 5a(C5a)and erythrocyte sedimentation rate(ESR)with the disease activity and prognosis in patients with systemic lupus erythematosus(SLE),and to investigate the values of C5aand ESR to the prediction of the prognosis of SLE.Methods A total of 198SLE patients(SLE group)were divided into inactive group(n=67),mild active group(n=54),moderate active group(n=41)and severe active group(n=36)according to the SLE disease activity index(SLEDAI).Another 60healthy volunteers were as controls(control group).SLE group was redivided into clinical remission group(n=137)and poor prognosis group(n=61)according to the prognosis 12months after treatment.The serum C5alevel and ESR were compared before and after treatment among groups.Pearson correlation analysis was used to analyze the correlations of serum C5alevel and ESR with SLEDAI.ROC was drawn to evaluate the efficacy of serum C5aplus ESR on the prediction of the prognosis of SLE.Results The serum C5alevel and ESR were higher in SLE group((95.61±16.04)ng/L,(51.22±6.37)mm/h)than those in control group((23.94±15.32)ng/L,(13.86±5.92)mm/h)(P<0.05),and increased gradually in turn in inactive group((31.34±14.20)ng/L,(23.86±5.72)mm/h),mild active group((68.55±13.63)ng/L,(41.22±5.95)mm/h),moderate active group((93.16±12.24)ng/L,(64.57±5.23)mm/h)and severe active group((127.58±13.75)ng/L,(91.34±6.49)mm/h)(P<0.05).The serum C5alevel and ESR were positively correlated with SLEDAI score(r=0.745,P<0.001;r=0.693,P<0.001).The serum C5alevel and ESR were higher in poor prognosis group((97.24±18.13)ng/L,(62.38±7.55)mm/h)than those in clinical remission group((45.19±16.57)ng/L,(27.04±6.92)mm/h)(P<0.05).When the optimal cut-off values of C5aand ESR were 73.59ng/L and 51.02mm/h,the AUCs for predicting poor prognosis of the patients with SLE were 0.843(95%CI:0.787-0.900,P<0.001)and 0.777(95%CI:0.707-0.849,P<0.001),with the sensitivities of 80.33%and 70.49%,and the specificities of 81.75%and 76.64%,respectively.The AUCof C5aco

关 键 词：系统性红斑狼疮 补体C5A 红细胞沉降率 疾病活动度 

分 类 号：R593.241[医药卫生—内科学]