血清淀粉样蛋白A与补体C3、C4联合检测对系统性红斑狼疮的临床诊断价值

Clinical value of combined determination of serum amyloid A,complement C3 and complement C4 in the diagnosis of systemic lupus erythematosus

目的探讨血清淀粉样蛋白A(SAA)、补体C3及C4联合检测对系统性红斑狼疮(SLE)的临床诊断价值。方法收集SLE患者133例为研究对象,根据SLE疾病活动指数(SLEDAI-2000)评分标准将SLE患者分为SLE活动期组48例、SLE稳定期组85例,另选取同期健康体检者50例为对照组。检测所有受试者的血清SAA、补体C3和C4水平,分析SAA水平与补体C3、C4水平的相关性,并采用受试者工作曲线(ROC曲线)和Logistic回归分析评估SAA、补体C3、C4单独和联合检测对SLE的诊断价值。结果SLE活动期患者SAA水平(35.71±16.99)mg/L,显著高于SLE稳定期患者SAA水平(7.23±1.16)mg/L和对照组SAA水平(6.38±0.73)mg/L(P<0.05),稳定期SLE患者SAA水平与对照组相比,差异无统计学意义(P>0.05)。SLE患者补体C3和C4水平均明显低于对照组,且活动期SLE患者补体C3、C4水平均低于SLE稳定期患者(P<0.05)。SAA、补体C3和C4的ROC曲线下面积(AUC)分别为0.86、0.96和0.91,三者联合检测的AUC为0.98且诊断效能明显升高,优于单项检测。相关性分析显示血清SAA与补体C3、C4均呈负相关(P<0.01)。SAA、补体C3和C4的联合Logistic回归方程对SLE的正确判断率为93.40%。结论SAA作为炎症指标在SLE患者中呈高表达,补体C3和C4水平在SLE患者中呈低表达,且SAA和补体C3、C4水平变化与SLE疾病活动度密切相关,三者联合检测对SLE具有较高灵敏度和特异性。

Objective To explore the clinical application of combined determination of serum amyloid A(SAA),complement C3 and complement C4 in the diagnosis of systemic lupus erythematosus(SLE).Methods A total of 133 SLE patients were selected for the study.According to the SLE disease activity index(SLEDAI-2000),SLE patients were divided into SLE active group(n=48)and SLE stable group(n=85).50 cases of healthy individuals were selected as the control group.The levels of SAA,complement C3 and complement C4 were determined.The correlation between serum SAA level and levels of complement C3 and C4 were analyzed.Receiver operating curve(ROC curve)and Logistic regression analysis were used to evaluate the diagnostic value of SAA,complement C3 and C4 in SLE.Results The SAA level in patients with active SLE was(35.71±16.99)mg/l,which was significantly higher than that in stable SLE patients(7.23±1.16mg/L)and that in control group(6.38±0.73)mg/L(P<0.05).There was no significant difference in SAA level between the stable SLE patients and the control group(P>0.05).The levels of complement C3 and C4 in patients with SLE were significantly lower than those in the control group,and the levels of complement C3 and C4 in patients with active SLE were lower than those in patients with stable SLE(P<0.05).The area under the ROC curve(AUC)of SAA,C3 and C4 were 0.86,0.96 and 0.91,respectively.The AUC of combined detection of SAA,C3 and C4 was 0.98,and the diagnostic efficiency was significantly improved,which was better than that of single detection.Correlation analysis showed that serum SAA was negatively correlated with complement C3 and C4(P<0.01).The correct judgment rate of the joint Logistic regression equation of SAA,complement C3 and C4 for SLE is 93.40%.Conclusion SAA,as an inflammatory index,is highly expressed in SLE patients,while complement C3 and C4 levels are low in SLE patients.The changes of SAA,C3 and C4 levels are closely related to the disease activity of SLE.The combined detection of SAA,C3 and C4 has high sensitivity and specificity for SLE.