血清脂蛋白相关磷脂酶A2、补体组分1q与膜性狼疮性肾炎活动性的相关性

Correlation of serum lipoprotein-associated phospholipase A2 and complement C1q with the activity of membranous lupus nephritis

目的:探究血清脂蛋白相关磷脂酶A2(Lp-PLA2)、补体组分1q(C1q)与膜性狼疮性肾炎(LN)活动性的相关性。方法:67例Ⅴ型LN患者根据系统性红斑狼疮疾病活动度评分表(SLEDAI)评分分为轻度活动组(n=41)、中重度活动组(n=26),同期53名健康志愿者为对照组。比较三组受试者的一般临床资料、血清Lp-PLA2、补体C1q水平、LN活动性指数(AI)和慢性化指数(CI)评分,分析Lp-PLA2、补体C1q与疾病活动性评分的相关性,并通过受试者工作特征曲线(ROC)评价Lp-PLA2、补体C1q预测膜性LN疾病活动性的价值。结果:三组的中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、超敏C反应蛋白(hs-CRP)和Lp-PLA2水平比较,对照组<轻度活动组<中重度活动组(P<0.05);三组的肾小球滤过率(c-aGFR)、补体C1q水平比较,对照组>轻度活动组>中重度活动组(P<0.05)。轻度活动组患者的LN活动性指数(AI)、SLEDAI评分小于中重度活动组,差异具有统计学意义(P<0.05);相关性分析结果显示Lp-PLA2与SLEDAI评分呈正相关(r=0.726,P<0.05),补体C1q与SLEDAI评分呈负相关(r=-0.637,P<0.05)。ROC曲线分析结果显示Lp-PLA2、补体C1q预测膜性LN患者疾病活动性的曲线下面积(AUC)分别为0.729和0.753,二者联合检测的AUC值为0.839,高于单个指标检测且差异均具有统计学意义(P<0.05)。结论:血清Lp-PLA2和补体C1q可作为预测膜性LN疾病活动性的重要血清学指标之一。

Objective:To explore the correlation of serum lipoprotein-associated phospholipase A2(Lp-PLA2)and complement C1q(C1q)with the activity of membranous lupus nephritis(LN).Methods:67 patients with type V LN were divided into mild active group(n=41)and moderate to severe active group(n=26)according to the systemic lupus erythematosus disease activity index(SLEDAI)score.Meanwhile,53 healthy volunteers were selected as the control group.General clinical data,serum Lp-PLA2 and C1q levels,activity index(AI)and chronicity index(CI)scores of LN were compared between the three groups.The correlation of Lp-PLA2 and C1q with disease activity score was analyzed.The receiver operating characteristic(ROC)curve was used to evaluate the value of Lp-PLA2 and C1q in predicting the activity of membranous LN.Results:The order neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),high sensitivity C-reactive protein(hs-CRP)and Lp-PLA2 levels in the three groups from low to high were as follows:the control group<mild active group<moderate to severe active group(P<0.05).The glomerular filtration rate(c-aGFR)and the order of C1q levels from high to low were as follows:the control group>mild active group>moderate to severe active group(P<0.05).The LN activity index(AI)and SLEDAI points of the mild active group were significantly lower than those of the moderate to severe active group,the difference was statistically significant(P<0.05).Correlation analysis showed that Lp-PLA2 was positively correlated with SLEDAI score(r=0.726,P<0.05),and C1q was negatively correlated with SLEDAI score(r=-0.637,P<0.05).ROC curve analysis showed that the area under the curve(AUC)values of Lp-PLA2 and C1q for predicting the activity of membranous LN were 0.729 and 0.753,respectively.The AUC value of the combined detection of the two was 0.839,which was significantly higher than that of single,and the difference was statistically significant(P<0.05).Conclusion:Serum Lp-PLA2 and C1q can be used as one of the important serological indicators to predict the activity of membranous LN.