多发性肌炎与皮肌炎患者血清补体C1q检测的临床意义

Serum complement C1q level in patients with polymyositis/dermatomyositis and its clinical significance

目的:探讨血清补体C1q水平对多发性肌炎/皮肌炎(PM/DM)患者的临床价值。方法:选取2016年1月至2018年12月在上海中医药大学附属曙光医院风湿科收治的PM/DM患者30例作为病例组,选取同期健康体检者30名作为对照组。检测所有研究对象血清中补体C1q、肌酸激酶(CK),同时检测PM/DM患者抗抗合成酶抗体(Jo-1)、抗中性粒细胞胞浆抗体(ANCA)、抗核糖核蛋白抗体(RNP)。比较不同临床症状和抗体表达的PM/DM患者血清中补体C1q和CK水平,绘制出研究对象受试者工作特征(ROC曲线)确定补体C1q和CK诊断PM/DM的效能。结果:与对照组相比,病例组患者血清中补体C1q[(241.26±26.10)mg/L vs(125.04±11.87)mg/L]和CK[(561.03±29.48)mU/ml vs(161.74±15.86)mU/ml]水平增高(t=22.201,P=0.026;t=65.331,P=0.012),但PM患者和DM患者血清中补体C1q[(254.63±29.24)mg/L vs(240.18±25.72)mg/L]及CK[(557.19±50.10)mU/ml vs(585.42±63.64)mU/ml]水平差异无统计学意义(t=1.427,P=0.165;t=1.358,P=0.185);有肌痛、四肢肌无力、雷诺现象、关节痛、向阳疹、肺间质病变、Gottron征、V字征、吞咽困难和其他脏器受累患者血清中补体C1q和CK水平高于无相应症状患者(P<0.05);Jo-1和ANCA阳性患者血清中补体C1q[(189.25±24.20)mg/L vs(352.19±30.22)mg/L;(207.31±16.29)mg/L vs(298.16±34.29)mg/L]和CK[(524.56±51.32)mU/ml vs(752.56±49.61)mU/ml;(497.36±54.28)mU/ml vs(651.22±58.26)mU/ml]水平低于阴性患者(χ^2=8.536,P=0.019;χ^2=7.694,P=0.037和χ^2=12.696,P=0.027;χ^2=10.763,P=0.046);抗RNP抗体阳性患者血清中补体C1q[(316.00±34.82)mg/L vs(225.46±41.38)mg/L]和CK[(624.18±26.10)mU/ml vs(468.25±24.27)mU/ml]水平高于阴性患者(χ^2=6.712,P=0.041;χ^2=11.751,P=0.038);补体C1q和CK诊断PM/DM的ROC曲线分别为0.842和0.783,约登指数分别为0.811和0.534,二者对诊断PM/DM都有一定的价值,但补体C1q的诊断价值高于CK,以231.820 mg/L作为临界值,补体C1q诊断的敏感度和特异度分别为88.95%和92.10%,均较高于CK(68.42%与85.00%)(约登指数0.811 vs 0.534,P<0.05)。结论:补体C1q在PM/DM患者血清中表达水平增高,并与PM/DM患者临床症状及抗体水平有关,可能参与了PM/DM疾病进展过程。

Objective To investigate the serum complement C1q level in patients with polymyositis/dermatomyositis(PM/DM)and its clinical significance.Methods Thirty patients with PM/DM admitted to the Department of Endocrinology in Shuguang Hospital from January 2016 to December 2018 were selected as the case group.Thirty healthy people for physical examination in the same period in Shuguang Hospital were selected as the control group.The levels of complement C1q and creatine kinase(CK)in the serum of all the subjects were detected.Meanwhile,the levels of anti-Jo-1 antibody(Jo-1),antineutrophil cytoplasmic antibodies(ANCA)and anti-ribonuclear protien antibody(RNP)in PM/DM patients were detected.The levels of complement C1q and CK in the serum of PM/DM patients with different clinical symptoms and antibody expression were compared.The working characteristics(ROC curve)were used to determine the diagnostic efficacy of complement C1q and CK for PM/DM.Results Compared with the control group,the levels of complement C1q[(241.26±26.10)mg/L vs(125.04±11.87)mg/L]and CK[(561.03±29.48)mU/ml vs(161.74±15.86)mU/ml]in serum of patients with PM and DM were higher(t=22.201,P=0.026;t=65.331,P=0.012),but there was no significant difference in the levels of complement C1q[(254.63±29.24)mg/L vs(240.18±25.72)mg/L]and CK[(557.19±50.10)mU/ml vs(585.42±63.64)mU/ml]between PM and DM(t=1.427,P=0.165;t=1.358,P=0.185).The serum complement C1q and CK in patients with myalgia,limb muscle weakness,Reynolds phenomenon,arthralgia,Yang rash,interstitial lung disease,Gottron sign,V sign,dysphagia and other organ-accumulated patients were increased(P<0.05).The levels of complement C1q[(189.25±24.20)mg/L vs(352.19±30.22)mg/L;(207.31±16.29)mg/L vs(298.16±34.29)mg/L]and CK[(524.56±51.32)mU/ml vs(752.56±49.61)mU/ml;(497.36±54.28)mU/ml vs(651.22±58.26)mU/ml]in patients with serum of Jo-1 or ANCA positive were lower than those of negative patients(χ^2=8.536,P=0.019;χ^2=7.694,P=0.037 andχ^2=12.696,P=0.027;χ^2=10.763,P=0.046).The levels of complement C1q[(316.00±34.82)mg/L vs(225.46±41.38)mg/L]and CK[(624.18±26.10)mU/ml vs(468.25±24.27)mU/ml]in serum of RNP positive patients were higher than those of negative patients(χ^2=6.712,P=0.041;χ^2=11.751,P=0.038).The ROC curves of complement C1q and CK in diagnosis of PM/DM were 0.842 and 0.783 respectively,and the Jordan index was 0.811 and 0.534 respectively,which had certain value for diagnosis of PM/DM,but that of the complement C1q level was higher than that of CK(P<0.05).The sensitivity and specificity of complement C1q were 88.95%and 92.10%respectively with 231.820 mg/L as the critical value,which was higher than that of CK(68.42%and 85.00%)(P<0.05).Conclusions The expression of complement C1q in serum of PM/DM patients is increased,which is related to the clinical symptoms and antibody levels of PM/DM patients.It may be involved in the progression of PM/DM disease.