大内皮素评估大动脉炎活动性的临床研究

Association between Big-Endothelin and Activity of Takayasu Arteritis

目的探讨大内皮素(big endothelin,Big ET)评估大动脉炎(Takayasu arteritis,TA)活动性的应用价值。方法采用回顾性研究方法,连续收集2015年1月至2018年12月在中国医学科学院阜外医院住院治疗的TA患者。以Kerr评分为标准,将TA患者分为活动组(Kerr评分≥2分)和非活动组(Kerr评分≤1分),比较两组间的临床资料。采用Spearman相关分析评价Big ET与Kerr评分、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)的关系。采用受试者工作特征(receiver operating characteristic,ROC)曲线确定判断TA活动性的界值。结果共收集166例TA患者,男25例,女141例,平均年龄(33.5±12.5)岁。活动组50例,非活动组116例。活动组与非活动组的Big ET[0.49(0.33,1.17)pmol/L比0.21(0.16,0.30)pmol/L,P<0.001]存在明显差异。Spearman相关分析Big ET与Kerr评分(r=0.550,P<0.001)、ESR(r=0.303,P<0.001)和CRP(r=0.350,P<0.001)呈正相关。Big ET判断TA疾病活动性的最佳界值为0.325 pmol/L,敏感度为79.2%,特异度为80.0%,ROC曲线下面积为0.848。结论Big ET有望成为判断TA炎症活动性的指标。

Objective To explore the relation between big-endothelin(Big ET)and Takayasu arteritis(TA).Methods TA patients admitted to Fuwai Hospital from January 2015 to December 2018 were consecutively recruited.They were divided into active and inactive groups according to Kerr scores.The clinical data collected from these two groups were analyzed with Spearman correlation analysis,which was used to evaluate the relationship between Big ET and disease activity(Kerr score or C-reactive protein or erythrocyte sedimentation rate).Receiver operating characteristic(ROC)curve was channeled into assessing the critical value of disease activity for TA patients.Results A total of 166 TA patients were collected,including 25 males(15.1%),with an average age of(33.5±12.5)years old,including 50 active patients and 116 inactive patients.Big ET performed significantly higher in active group than that in the inactive group[0.49(0.33,1.17)pmol/L vs 0.21(0.16,0.30)pmol/L,P<0.001].Spearman correlation analysis revealed that Big ET was positively correlated with Kerr score(r=0.550,P<0.001),erythrocyte sedimentation rate(r=0.303,P<0.001)and C-reactive protein(r=0.350,P<0.001).A Big ET level of 0.325 pmol/L was proved to be the best predictive cut-off value for TA disease activity(sensitivity 79.2%,specificity 80.0%,and area under the curve was 0.848).Conclusion Big ET may be used as an indicator of TA inflammatory activity.