系统性红斑狼疮患者血Cys-C、尿NGAL水平变化及其临床意义

Change and their clinical significance of serum Cys-C and urine NGAL levels in patients with systemic lupus erythematosus

目的研究血清胱抑素C（Cys-C）及尿中性粒细胞明胶酶相关载脂蛋白（NGAL）在系统性红斑狼疮（SLE）肾损害中的水平变化及其临床意义。方法选择2012年10月-2015年10月经我院收治住院的158例SLE患者为实验组,其中有肾损害的狼疮性肾炎（LN）患者116例,非肾炎SLE患者42例,入选对象均符合美国风湿病协会（ACR）2009年修订的SLE诊断标准;同期健康体检者90例为对照组,分析三组血Cys-C、尿NGAL水平与传统肾实验项目指标（BUN、Cr）及受试者操作特征（ROC）曲线变化。结果实验组血Cys-C、尿NGAL水平高于对照组,差异有统计学意义（P〈0.01）;与非肾炎SLE患者比较,LN患者血Cys-C、尿NGAL水平显著升高,差异有统计学意义（P〈0.01）,提示血Cys-C及尿NGAL在SLE早期肾损害诊断中优于BUN、Cr;ROC曲线分析显示,采用血Cys-C联合尿NGAL诊断SLE肾损害可获得最佳的诊断灵敏度（90.52%）及特异度（96.21%）,优于血Cys-C或尿NGAL单独检测。结论血Cys-C、尿NGAL可作为SLE患者肾损害早期检测的可靠指标,两者联合检测可明显提高LN诊断的灵敏度及特异度。

Objective To study the change of serum Cys-C and urine NGAL levels in patients with systemic lupus erythematosus（SLE） renal damage and their clinical significance. Methods 158 SLE patients treated in our hospital from October 2012 to October 2015 were selected as the study group,of which 116 patients were with lupus nephritis（LN）,and 42 were without renal damage.All patients selected were in accordance with SLE diagnostic criteria revised by ACR in 2009.90 healthy volunteers were selected as the control group.The levels of serum Cys-C,urine NGAL,and conventional renal indexes including BUN and Cr were analyzed among three groups,and receiver operating characteristic（ROC） curve analysis was also conducted. Results The levels of serum Cys-C and urine NGAL were significantly higher in the study group than those in the control group（P〈0.01）.The levels of serum Cys-C and urine NGAL were significantly higher in the LN group than those in the non-LN SLE group（P 0.01）,which showed that the application of serum Cys-C and urine NGAL was superior in early diagnosis of SLE to BUN and Cr.The result of ROC curve analysis showed that serum Cys-C combined with urine NGAL could achieve optimal sensibility（90.52%） and specificity（96.21%） of diagnosis in renal damage of SLE,which was superior to single use of either of them. Conclusion Serum Cys-C and urine NGAL can be used as reliable indexes in early diagnosis of SLE renal damage.The combination of them can significantly enhance the sensibility specificity of LN diagnosis.