狼疮性肾炎患者血清胆红素水平的变化及意义

Changes and Significance of Serum Bilirubin Level in Patients with Lupus Nephritis

目的探讨狼疮性肾炎(LN)患者血清胆红素对疾病活动性评价的意义。方法以2016年5月~2018年9月收治的100例系统性红斑狼疮(SLE)住院患者为研究对象,以有无肾脏损害分为SLE组和LN组,每组各50例,同期选择健康体检者50例为HC组。采用方差分析统计各组血清总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)水平的差异,pearson相关分析统计胆红素与SLE疾病活动指数(SLEDAI)评分、胱抑素C(CysC)、C反应蛋白(CRP)水平的相关性,多因素logistic回归分析进一步分析血清胆红素与LN的相关性,ROC曲线评价TBIL、IBIL、DBIL对LN诊断的敏感度、特异性。结果SLE组、LN组TBIL、IBIL水平明显低于HC组(P<0.05),LN组TBIL、IBIL、DBIL水平明显低于SLE组(P<0.05);LN组TBIL、IBIL、DBIL水平与SLEDAI评分呈负相关(r=-0.489,P<0.05;r=-0.427,P<0.05;r=-0.381,P<0.05),与CysC水平呈负相关(r=-0.512,P<0.05;r=-0.423,P<0.05;r=-0.375,P<0.05),与CRP浓度水平呈负相关(r=-0.398,P<0.05;r=-0.324,P<0.05;r=-0.318,P<0.05);TBIL、IBIL、DBIL对于诊断LN的敏感度为80.00%、78.00%、50.00%,特异性为78.00%、76.00%、80.00%。结论血清胆红素可作为评估LN疾病活动性和肾功能损伤程度的一种新型标志物。

Objective To explore the significance of serum bilirubin in the evaluation of disease activity in patients with lupus nephritis(LN).Methods From May 2016 to September 2018,a total of one hundred systemic lupus erythematosus(SLE)patients as well as fifty healthy volunteer were enrolled in this study.SLE patients were divided into SLE group(n=50)and LN group(n=50)with or without renal damage.Variance analysis was used to analyze the differences of serum total bilirubin(TBIL),direct bilirubin(DBIL)and indirect bilirubin(IBIL)levels.Pearson correlation analysis was employed to further identify the correlation of these factorsand SLE disease activity index(SLEDAI)score,cystatin C(CysC)and C-reactive protein(CRP).Multivariate logistic regression analysis further analyzed the correlation between serum bilirubin and LN.ROC curve evaluated the sensitivity and specificity of TBIL,IBIL and DBIL in the diagnosis of LN.Results The levels of TBIL and IBIL were significantly lower in SLE group and LN group than HC group(P<0.05),and the levels of TBIL,IBIL and DBIL also significantly lower in LN group than SLE group(P<0.05).In LN group,TBIL,IBIL and DBIL level was respectively negatively correlated with SLEDAI score,CysC level and CRP concentration[(r=-0.489,P<0.05;r=-0.427,P<0.05;r=-0.381,P<0.05),(r=-0.512,P<0.05;r=-0.423,P<0.05;r=-0.375,P<0.05),(r=-0.398,P<0.05;r=-0.324,P<0.05;r=-0.318,P<0.05)].TBIL、IBIL、DBIL were protective factors for the pathogenesis of LN;The sensitivity of TBIL,IBIL and DBIL for the diagnosis of LN was 80.00%,78.00%and 50.00%,and the specificity was 78.00%,76.00%and 80.00%,respectively.Conclusion Bilirubin level can be used as a new biomarker to evaluate the degree of LN disease activity and renal function injury.