系统性红斑狼疮患儿血清IL-18、IL-23及MCP-1水平变化及其临床意义

Changes and clinical significance of serum IL-18,IL-23 and MCP-1 levels in children with systemic lupus erythematosus

目的探讨系统性红斑狼疮(SLE)患儿血清白细胞介素-18(IL-18)、白细胞介素-23(IL-23)及单核细胞趋化蛋白-1(MCP-1)水平变化及其临床意义。方法选取2016年1月至2019年9月该院收治的SLE患儿138例为SLE组,另选取体检健康者60例为对照组。采用SLE病情活动指数(SLEDAI)评分将138例SLE患儿分为低活动组66例(SLEDAI评分<9分)和高活动组72例(SLEDAI评分≥9分)。采用酶联免疫吸附测定检测各组血清IL-18、IL-23及MCP-1水平;应用受试者工作特征曲线(ROC曲线)分析血清IL-18、IL-23及MCP-1水平对儿童SLE的诊断价值;采用Pearson相关分析SLE患儿血清IL-18、IL-23及MCP-1水平与其他实验室指标的相关性。结果SLE组抗双链DNA(dsDNA)抗体、C-反应蛋白、IL-18、IL-23、MCP-1水平高于对照组,血红蛋白、血小板计数、补体C3、补体C4及清蛋白水平低于对照组,差异均有统计学意义(P<0.05)。高活动组血清IL-18、IL-23及MCP-1水平高于低活动组,差异均有统计学意义(P<0.05)。ROC曲线结果显示,血清IL-18、IL-23及MCP-1水平诊断儿童SLE的最佳临界值分别为227.50、94.46、161.28 pg/mL,三项指标联合诊断儿童SLE的曲线下面积为0.924,其灵敏度(93.6%)和特异度(87.0%)较高。相关分析显示,SLE患儿血清IL-18、IL-23、MCP-1水平与SLEDAI评分及抗dsDNA抗体水平均呈正相关(P<0.05)。结论SLE患儿血清IL-18、IL-23及MCP-1水平明显升高,且与疾病的活动性相关,三项指标联合检测对儿童SLE的诊断有一定价值。

Objective To investigate the changes and clinical significance of serum interleukin-18(IL-18),interleukin-23(IL-23)and monocyte chemoattractant protein-1(MCP-1)in children with systemic lupus erythematosus(SLE).Methods From January 2016 to September 2019,138 SLE children in the hospital were selected as SLE group,and 60 healthy subjects were selected as control group.The disease activity index(SLEDAI)score was used to divide 138 SLE children into low activity group(66 cases with SLEDAI score<9 points)and high activity group(72 cases with SLEDAI score≥9 points).The levels of serum IL-18,IL-23 and MCP-1 were detected by enzyme-linked immunosorbent assay(ELISA);the diagnostic value of serum IL-18,IL-23 and MCP-1 in children with SLE was analyzed by receiver operating characteristic curve(ROC curve);the correlations between serum IL-18,IL-23,MCP-1 levels and other laboratory indexes were analyzed by Pearson correlation analysis.Results The levels of anti double(dsDNA)antibody,C-reactive protein,IL-18,IL-23 and MCP-1 in SLE group were higher than those in control group,while the levels of hemoglobin,plate let count,complement C3,complement C4 and albumin in SLE group were lower than those in control group(P<0.05).The serum levels of IL-18,IL-23 and MCP-1 in high activity group were higher than those in low activity group(P<0.05).ROC curve showed that the best cut-off values of serum IL-18,IL-23 and MCP-1 levels in the diagnosis of SLE in children were 227.50,94.46,161.28 pg/mL respectively.The area under the curve for the combined diagnosis of the three indicators was 0.924,with high sensitivity(93.6%)and specificity(87.0%).Correlation analysis showed that the serum levels of IL-18,IL-23 and MCP-1 positively correlated with SLEDAI score and anti dsDNA antibody level(P<0.05).Conclusion The serum levels of IL-18,IL-23 and MCP-1 in children with SLE significantly increased,which related to the disease activity.The combined detection of the three indexes has certain value in the diagnosis of SLE in children.