系统性红斑狼疮中血浆蛋白S和生长阻抑特异性蛋白6的检测及其临床意义

Detection of plasma protein S and growth-arrest specific protein 6 and their clinical significance in systemic lupus erythematosus

目的探讨蛋白S和生长阻抑特异性蛋白6（Gas6）在SLE中的临床意义。方法应用ELISA检测103例SLE患者与40名健康对照组血浆中蛋白S和Gas6的浓度，并分析比较其与SLE患者各种临床表现及实验室指标的关系。采用Mann-Whitney U检验、X2检验和Spearman相关性分析进行统计学分析。结果SLE患者血浆中，蛋白S和Gas6的浓度均明显低于健康对照组[蛋白S：30．6（27．2，33．6）与37．8（35．4，46．7）μg／ml，Z=6．04，P〈O．01；Gas6：402．6（239．2，757．8）与913．6（765．0，1290．6）pg／ml，Z=4．26，P〈0．01]，蛋白s与Gas6浓度呈正相关（r=0．312，P=0．001）。血浆蛋白s浓度与SLE患者外周血血红蛋白、白细胞计数、血小板计数、补体c3及补体c4水平呈正相关（r值分别为：O．209，0．264，0．264，O．362，O．280，P〈0．01或P〈0．05），与抗dsDNA抗体、抗心磷脂抗体、抗核小体抗体以及IgG呈负相关（r值分别为-0．197，-0．264，-0．226，-0．229，P〈0．01或P〈0．05）；血浆Gas6水平与SLE患者年龄、病程以及CRP呈正相关（r值分别为：0．229，0．198，0．263，P〈0．01或P〈0．05）；Gas6减低患者发热、皮疹及浆膜炎发生率显著高于Gas6正常者。SLE患者中，外周血白细胞减低者、蛋白尿阳性者Gas6的浓度低于白细胞、蛋白尿正常者（P〈0．05）。结论SLE患者血浆中蛋白S水平显著降低，并与血液系统损害、补体系统侵及以及自身抗体产生相关；血浆Gas6水平也显著降低，且与年龄、病程、皮肤、肾损害及炎症等临床特点相关。

Objective To investigate the significance of plasma protein S and growth-arrest specific protein 6 （Gas6） in systemic lupus erythematosus （SLE）. Methods Sandwich enzyme-linked immunosorbent assay （EL1SA） was used to measure the protein S and Gas6 in the plasma of 103 SLE patients and 40 healthy controls. Mann-Whitney U-test, X2-test and Spearman＇s rank correlation were used for statistical analysis. Results The plasma concentrations of protein S and Gas6 were both significantly [protein S： 30.6（27.2, 33.6） pμg/ml, 37.8（35.4, 46.7） pμg/inl, Z=6.04, P〈0.01; Gas6： 402.6（239.2, 757.8） pg/ml, 913.6（765.0, 1 290.6） pg/ml, Z=4.26, P〈0.01 ] decreased in plasma of SLE patients than that in healthy controls. There was a positive correlation between levels of protein S and Gas6 （r=0.312, P=0.001）. The level of protein S in SLE patients was positively correlated with hemoglobin （Hb）, WBC, platelet blood platelet （PLT）, C3 and C4 （r=0.209, 0.264, 0.264, 0.362, 0.280, P〈O.01 or P〈0.05）. Plasma protein S level was also found to be negatively correlated with auto-antibodies such as anti-double strand DNA （anti-dsDNA） antibody, anti- eardiolipin （ACL）, anti-nucleosome antibody （AnuA） or IgG （r=-0.197, -0.264, -0.226, -0.229, P〈0.01 or P〈0.05 ）. The plasma Gas6 level was positively associated with age, disease duration and C-reaction protein （CRP） （r--0.229, 0.198, 0.263, P〈0.01 or P〈0.05）. Patients with decreased Gas6 level showed higher incidence of fever, rash and serositis. Patients with decreased WBC or positive for proteinuria also showeddecreased Gas6 （P〈0.05）. Conclusion Protein S levels are significantly decreased in plasma of SLE patients and is associated with a series of severe disease manifestations such as hematological involvement, decreased complements and the presence of auto-antibodies. Decreased Gas6 levels in SLE patients are observed and they are correlated with age, disease duration and certain clinical characteristics such as rash, renal involvement and inflammatory response.