狼疮肾炎中医风湿内扰证候与血Fractalkine及尿血管细胞黏附分子-1的相关性研究

Clinical Study on Correlation between Serum Fractalkine,Urine Vascular Cellular Adhesion Molecule-1 and Endorheumatism Syndrome in Lupus Nephrits

目的:通过分析狼疮肾炎患者血Fractalkine(FKN)以及尿血管细胞黏附分子-1(vascular cellular adhesion molecule-1,VCAM-1)的水平及实验室常用指标与中医风湿内扰证候之间的关系。方法:对确诊为66例狼疮肾炎患者进行辨证分型分为风湿内扰组36例及非风湿内扰组30例。另选取健康体检的正常人20例作为对照组,收集临床资料及实验室指标并同步留取血、尿标本,ELISA法检测86例标本血Fractalkine与尿VCAM-1水平,综合分析风湿内扰证候与上述指标之间的关系。结果:(1)风湿内扰组患者较非风湿内扰组易出现发热乏力(45.8%VS 19.2%)、关节炎(29.2%VS 3.8%)、高血压(35.9%VS 7.7%)、浮肿(41.7%VS 0%)(P<0.05);(2)风湿内扰组患者血Fractalkine(1.78±1.19 VS 0.94±0.83)及尿VCAM-1(62.37±27.65 VS 27.21±30.14)水平均显著高于非风湿内扰组(P<0.01);血红蛋白定量(113.29±29.21 VS 127.04±12.32)、血白蛋白定量(34.77±6.92 VS 43.33±3.08)均低于非风湿内扰组(P<0.05);风湿内扰组24 h尿蛋白定量水平(2170.01±1469.30 VS 278.25±178.86)、尿红细胞定量(10.00(0.75,20.00)VS 0.00(0.00,0.75))均高于非风湿内扰组,(P<0.01);风湿内扰组中血C3水平低于非风湿内扰组,ANA滴度、anti-dsDNA及anti-SM阳性率明显高于非风湿内扰组(P<0.05);风湿内扰组SLEDAI积分、BILAG积分均高于非风湿内扰组(P<0.01);(3)风湿内扰证候与血Fractalkine、尿VCAM-1、尿红细胞、24 h尿蛋白、SLEDAI积分、BILAG积分、ANA滴度呈正相关(P<0.01),与血白蛋白呈负相关(P<0.01)。(4)风湿内扰组病理类型以IV型及IV+V型为主。结论:狼疮肾炎风湿内扰证候与疾病活动度密切相关,当临床出现风湿内扰证时需警惕狼疮肾炎疾病的活动。

Objective:The aim was to explore the correlation between the levels of serum Fractalkine,urine Vascular cellular adhesion molecule-1(VCAM-1)and common laboratory activityindicators in lupus nephritis(LN)patients with the endorheumatism syndrome in LN.At the same time,to provide objective standard for the micro differentiation and clinical evaluation of treatments for traditional Chineses medicine syndromes.Methods:Totally 68 LN patients and 20 healthy volunteers were enrolled in this study.Sixty-eight LN patients were assigned to endorheumatism group(36 cases)and non-endorheumatism group(30 cases).Twenty healthy volunteers were taken as the normal control group.Clinical data, serum and urine samples were collected from all enrollers.The levels of serum Fractalkine and urine VCAM-1 were detected by ELISA.Result:(1)Patients in the endorheumatism group compared with the group of non-endorheumatism were more prone to get fever(37.5% VS 7.7%), fatigue(45.8% VS 19.2%), arthritis(29.2% VS 3.8%), hypertension(35.9% VS 7.7%), edema(41.7% VS 0%)(P<0.05).(2)The endorheumatism group's levels of serum Fractalkine[(1.78±1.19)VS(0.94±0.83)] and uVCAM-1 [(62.37±27.65)VS(27.21±30.14)] were statistically significant higher than those of the group of non-endorheumatism group(P<0.01).The levels of hemoglobin[(113.29±29.21)VS(127.04±12.32)] and serum albumin[(34.77±6.92)VS(43.33±3.08)] were lower than those of the non-endorheumatism group, which constituted a statistically significant difference(P>0.05), especially the serum albumin levels(P<0.01).The 24-hour urinary protein levels [(2 170.01±1 469.30)VS(278.25±178.86)], uRBC levels[(10.00(0.75,20.00)VS 0.00(0.00,0.75)] in the endorheumatism group were higher than that of the non-endorheumatism group.There were statistically significant differences(P<0.01).The ANA titers, anti-SM and anti-dsDNA positive rate in the endorheumatism group was statistically significantly higher than that of the non-endorheumatism group,but serum C3 levels was lower(P<0.05).The scores of SLEDAI in the endorheumatism group were higher than that of the non-endorheumatism group,which constituted a statistically significant differences(P<0.01).(3)The Endorheumatism syndrome was positively correlated with the levels of serum Fractalkine,uVCAM-1,uRBC and 24-hour proteinuria as well as the scores of SLEDAI and BILAG, and it was also positively correlated with the ANA titers(P<0.01), while negatively correlated with the levels of serum albumin(P<0.01).(4)The mainly pathological type in the endorheumatism group was type IV and IV+V.Conclusion:Among patients with lupus nephritis, the endorheumatism syndrome is closely related to the disease activity.We need to guard against the disease activity,when the endorheumatism syndrome appears in clinic.