SLE血清抗α-辅肌动蛋白对狼疮性肾炎的早期预测价值研究

Early predictive value of serum anti-α-actinin antibody on lupus nephritis in SLE patients

目的讨血清抗α-辅肌动蛋白抗体(anti-alpha-actinin antibody,AαA)、补体水平及血清蛋白对狼疮性肾炎(lupus nephritis,LN)发病的预测价值。方法以212例系统性红斑狼疮(systemic lupus erythematosus,SLE)患者为研究对象,前瞻性观测LN的发生,39例进展为LN,173例未出现LN。采用ELISA法检测血清AαA水平、抗双链DNA抗体(anti-double-stranded DNA antibody,anti-dsDNA)及抗心磷脂抗体(anticardiolipin antibody,ACA)等,采用全自动生化分析仪检测血清补体水平及肝功能指标。结果 LN组与非LN组平均年龄分别为(30.2±7.6)岁与(38.3±8.2)岁,LN组患者年龄相对较低(t=5.645,P<0.001)。LN组SLE诊断时即出现白球比倒置,LN组白蛋白与球蛋白的比值(albumin to globulin ratio,AGR)平均值显著低于非LN组(t=3.975,P<0.001)。LN组血清AαA与补体C3平均水平分别为(82.5±36.2) pg/m L与(53.2±26.3) mg/d L,均显著低于非LN组(P<0.05)。Cox风险比例回归分析结果显示年龄、血清AαA、AGR及补体C3水平是患者发生LN的独立影响因素。受试者工作特征曲线(receiver operating characteristic curve,ROC)分析结果显示,血清AαA诊断效能最高,曲线下面积(area under the curve,AUC)=0.845(95%CI:0.776～0.915,P<0.001);其次为AGR,AUC=0.774(95%CI:0.776～0.915,P<0.001);年龄与补体C3的AUC分别为0.594与0.728。结论 SLE血清AαA与AGR水平降低与LN的发生存在强相关性,低龄与低血清C3也增加了LN的发生风险,上述指标的监测有助于LN的早期诊断与干预。

Objective To explore the predictive value of serum levels of anti-α-actinin antibody,complements and serum protein on lupus nephritis in the diagnosis of lupus nephritis(LN) in SLE patients.Methods A total of 212 patients with SLE were enrolled into this study,39 of 212 patients developed LN during the follow-up.The levels of serum AαA,Anti-dsDNA and ACA were detected with ELISA.The serum complements levels and liver function indexes were detected by automatic biochemical analyzer.Results The mean ages of the LN group and the non-LN group were(30.2 ± 7.6)years and(38.3 ± 8.2) years,respectively(t = 5.645,P < 0.001).The mean albumin to globulin ratio(AGR) of LN group was significantly lower than that of the non-LN group(t = 3.975,P < 0.001).The mean levels of serum AαA and complement C3 in the LN was(82.5 ± 36.2) pg/ml and 53.2 ± 26.3 respectively,which were both lower than those in non-LN group(P < 0.05).Cox risk ratio regression analysis showed that the age,serum AαA,AGR and complement C3 were the independent factors for the incidence of LN in SLE patients.ROC analysis showed that serum AαA had the highest diagnostic efficiency(AUC = 0.845,95% CI:0.776-0.915.P < 0.001),followed by AGR(AUC = 0.774,95%CI:0.776-0.915.P < 0.001),then was AUC of age and complement C3 level(ACU = 0.594 and 0.728,respectively).Conclusion There is a strong correlation between low AαA and low AGR levels and LN at the diagnosis of SLE.The younger age and lower serum C3 level also increase the risk of LN.The early diagnosis and intervention of LN can be achieved by monitoring the above indexes.