狼疮肾炎中医风湿证候与活动性指标的相关性研究

Correlation Study between Lupus Nephritis Patients of Rheumatism Syndrome and SLEDAI: a Clinical Study

目的分析狼疮肾炎患者尿单核细胞趋化因子-1(MCP-1)、尿γ干扰素诱导蛋白(IP-10)水平及临床各项活动性指标与中医风湿证候的关系,为风湿证候微观辨证提供客观依据。方法选取狼疮肾炎患者60例,分为风湿证候组(31例)与无风湿证候组(29例),另设健康组(20名)作为对照,收集临床资料,进行肾脏病理活动性及全身活动性评分,检测患者尿MCP-1与IP-10水平,综合分析风湿证候与各项活动性指标及临床活动性表现的相关性。结果 (1)风湿证候组较无风湿证候组更易出现发热、浆膜炎、浮肿及高血压(P<0.05);(2)风湿证候组具有更高的尿MCP-1、尿IP-10、24 h尿蛋白定量及血尿素氮水平,其镜下血尿、抗ds-DNA、抗Sm、抗核小体的阳性率、系统性红斑狼疮疾病活动指数(SLEDAI)及英国狼疮评估小组(BILAG)积分均高于无风湿证候组(P<0.05),血清白蛋白及补体C3水平低于无风湿证候组(P<0.05)。(3)风湿证候组患者肾病理活动指数(AI)平均值高于无风湿证候组患者,病理类型以Ⅳ型最多。结论狼疮肾炎风湿证候患者较无风湿证候患者具有更严重的肾脏病变及免疫学异常;风湿证候与狼疮肾炎临床活动性指标密切相关。

Objective To explore lupus nephritis （LN） patients＇ monocyte chemotactic protein 1 （MCP-1） and urinary IP-10 （ulP-10） levels, the correlation between each clinical activity index and rheu- matism syndrome, thereby proving objective evidence for microscopic typing of rheumatism syndrome. Methods Totally 60 LN patients were assigned to the rheumatism group （31 cases） and the non-rheu- matism group （29 cases）. Besides, 20 healthy volunteers were recruited as the normal control group. Clinical data and renal pathology were collected, and urinary levels of MCP-1 and IP-10 detected by ELISA. The correlation between rheumatism syndrome and each activity index as well as manifestations of clinical activities was comprehensively analyzed. Results （1） Patients in the rheumatism group were more liable to occur fever, serositis, edema, and hypertension （P 〈0.05）. （2） Compared with the non- rheumatism group, patients in the rheumatism group exhibited much higher levels of 24 h protein quantifi- cation and blood urea nitrogen, higher levels of uMCP-1 and ulP-10. Microscopic hematuria, anti-ds-DNA, anti-Sm, the positive rate of AnuA, scores of SLEDAI and BILAG were higher in the rheumatism group than in the non-rheumatism group （P 〈0.05）. Levels of plasma albumin and complement C3 were lower in the rheumatism group than in the non-rheumatism group （P 〈0.05）. （3） The average activity index （AI） of the renal pathology was higher in the rheumatism group than in the non-rheumatism group. The most frequent pathological type of rheumatism group was type 1V of LN. Conclusions More severe renal dam- age and immune abnormality occurred in LN patients of rheumatism syndrome. Rheumatism syndrome is closely correlated to clinical activity indices.