血尿酸和胆固醇联合检测对系统性红斑狼疮患者蛋白尿的预测价值  

Predictive value of combined detection of serum uric acid and cholesterol for proteinuria in patients with systemic lupus erythematosus

作　　者：刘海俊 马剑达[2] 李谦华[2] 欧阳霞 刘讷敏 邓振波 韦秀宁[2] LIU Hai-jun;MA Jian-da;LI Qian-hua;OUYANG Xia;LIU Ne-min;DENG Zhen-bo;WEI Xiu-ning(Department of Rheumatology,Panyu Central Hospital,Guangzhou 511400,Guangdong China)

机构地区：[1]广州市番禺区中心医院风湿免疫科,广东广州511400 [2]中山大学孙逸仙纪念医院风湿免疫科,广东广州510120

出　　处：《广东医学》2023年第4期456-461,共6页Guangdong Medical Journal

基　　金：广东省医学科学技术研究基金项目(A2019131)。

摘　　要：目的探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)患者的血尿酸联合胆固醇检测对蛋白尿的预测价值。方法纳入2020年3月至2020年7月门诊及住院的SLE患者309例为SLE组,以242名年龄、性别匹配的健康人群为对照组。检测SLE患者血尿酸、血脂水平及其他临床指标(性别、年龄、体重、系统性红斑狼疮疾病活动指数(SLEDAI)评分、肾脏指标(肌酐、尿常规、24 h尿蛋白定量)、C反应蛋白(CRP)、红细胞沉降率、SLE血清学活动指标(补体C3、补体C4和抗dsDNA)及当前糖皮质激素用量。根据24 h尿蛋白定量结果将309例SLE患者(SLE组)分为两亚组:蛋白尿亚组63例[24 h尿蛋白>0.5 g)和非蛋白尿亚组246例(24 h尿蛋白≤0.5 g)。以logistic回归分析SLE患者蛋白尿的危险因素,以受试者操作特征(receiver operator characteristic,ROC)曲线评价血尿酸、胆固醇对蛋白尿的预测价值。结果SLE组的高尿酸血症(≥360μmol/L)比例显著高于对照组(P=0.001);SLE组血三酰甘油水平显著高于对照组(P<0.001),高密度脂蛋白显著低于对照组(P<0.001);蛋白尿亚组的血尿酸、胆固醇、三酰甘油显著高于非蛋白尿亚组(均P<0.001),其中尿酸、胆固醇水平升高是SLE患者出现蛋白尿的危险因素(OR分别为1.004、1.486,均P<0.001)。ROC曲线提示尿酸、胆固醇的曲线下面积分别为0.739、0.754(P<0.001),阈值分别为335.50μmol/L、4.73 mmol/L。尿酸、胆固醇同时超过阈值预测蛋白尿的特异度最高(91.46%,P<0.001)。结论SLE患者的血尿酸及胆固醇升高与蛋白尿密切相关,尿酸与胆固醇水平可能对蛋白尿有一定预测价值。Objective To investigate the predictive value of combined detection serum uric acid and cholesterol on proteinuria in patients with systemic lupus erythematosus(SLE).Methods A total of 309 SLE patients(SLE group)were divided into two subgroups:proteinuria subgroup(24 h proteinuria>0.5 g,63 cases)and non-proteinuria subgroup(24 h proteinuria≤0.5 g,246 cases).And 242 healthy people with matched age and sex were enrolled as the control group.Serum uric acid,blood lipid levels,and other clinical indicators were collected.Logistic regression was used to analyze the risk factors of proteinuria in patients with SLE,and receiver operator characteristic curve(ROC)curve was used to evaluate the predictive value of serum uric acid and cholesterol on proteinuria.Results The proportion of hyperuricemia(≥360μmol/L)in the SLE group was significantly higher than that in the control group(P<0.001).The blood triglyceride level in the SLE group was significantly higher than that in the control group(P<0.001),while the high density lipoprotein was significantly lower than that of the control group(P<0.001).The serum uric acid,cholesterol and triglyceride in proteinuria subgroup were significantly higher than those in the non-proteinuria subgroup(P<0.001).The ROC curve indicated that the areas under the curve of uric acid and cholesterol were 0.739 and 0.754,respectively(P<0.001),with the thresholds were 335.50μmol/L and 4.73 mmol/L,respecitvely.Uric acid and cholesterol both exceeding the thresholds had the highest specificity for prediction of proteinuria(91.46%,P<0.001).Conclusion The elevated of serum uric acid and cholesterol in SLE patients is closely correlated to proteinuria,and uric acid and cholesterol levels have high predictive value for proteinuria.

关 键 词：系统性红斑狼疮 尿酸 胆固醇 狼疮性肾炎 

分 类 号：R593.241[医药卫生—内科学] R446.112[医药卫生—临床医学]