α1球蛋白水平在抗中性粒细胞胞浆抗体相关性血管炎中的临床意义

The clinical significance of α1-globulin in anti-neutrophil cytoplasmic antibody associated vasculitis

目的探讨血清蛋白质组分(serum protein fractions,SPFs)变化在抗中性粒细胞胞浆抗体相关性血管炎(antineutrophil cytoplasmic antibody associated vasculitis,AAV)中的临床意义。方法回顾性分析2017年1月至2019年6月我院38例AAV患者的临床资料,通过血清蛋白电泳分析SPFs,采用Spearman法进行相关性分析,Kaplan-Meier进行生存分析,受试者工作特征曲线分析肾脏进展预测效能。结果SPFs组分中,α1球蛋白水平与伯明翰血管炎活动性评分(Birmingham vasculitis activity score,BVAS)(r=0.3827,P=0.0177)、血清肌酐(r=0.4641,P=0.0033)、C反应蛋白(C reactive protein,CRP)(r=0.616,P<0.0001)、血沉(r=0.3859,P=0.0183)、白介素6(r=0.4688,P=0.0059)、D-二聚体(r=0.5978,P=0.0001)呈正相关;以α1球蛋白均值(7.22%)为截点,将患者分为α1球蛋白高水平组和低水平组,发现高水平组患者肾脏累积生存率低于低水平组(Log rank=7.782,P=0.005);α1球蛋白水平对肾脏预后的预测效能(AUC=0.759)优于BVAS、CRP(AUC=0.639,0.551)。结论血清α1球蛋白水平与AAV活动度及预后相关,有望成为评估活动性及预测预后的生物学标志物。

To investigate the clinical significance of serum protein fractions(SPFs)in patients with antineutrophil cytoplasmic antibody associated vasculitis(AAV),38 patients were recruited and retrospective observationally analyzed in our department from January 2017 to June 2019.The levels of SPFs were evaluated by serum protein electrophoresis(SPE).Spearman correlation test showed that the levels ofα1-Globulin were positively correlated with Birmingham vasculitis activity score(BVAS)(r=0.3827,P=0.0177),initial serum creatinine(r=0.4641,P=0.0033),C reactive protein(CRP)(r=0.616,P<0.0001),erythrocyte sedimentation rate(r=0.3859,P=0.0183),interleukin-6(r=0.4688,P=0.0059)and D-dimer(r=0.5978,P=0.0001).The patients were further divided into high levels ofα1-Globulin group and low levels ofα1-Globulin group based on the average level ofα1-Globulin(7.22%).Kaplan-Meier survival analysis showed that cumulative renal survival rate were significantly lower in patients with high levels ofα1-Globulin than that of patients with low levels ofα1-Globulin(Log rank=7.782,P=0.005).Furthermore,the receiver operating characteristic curve showed that the prediction performance ofα1-Globulin for renal survival(AUC=0.759)is better than BVAS and CRP(AUC=0.639,0.551).In conclusion,the level of serumα1-Globulin is related to the disease activity and renal prognosis of AAV patients,and might be an index for evaluating the disease activity and predicting the prognosis.