外周血ADAMT-13、CD154、sTM在SLE合并血栓性微血管病中的水平变化及临床意义

Levels and Clinical Significance of ADAMT-13,CD154 and sTM in Peripheral Blood of Patients with Systemic Lupus Erythematosus Complicated with Thrombotic Microangiopathy

目的探究外周血血管性血友病因子裂解蛋白酶(ADAMT)-13、B淋巴细胞表面CD154、可溶性血栓调节蛋白(sTM)在系统性红斑狼疮(SLE)合并血栓性微血管病(TMA)中的水平变化及临床意义。方法选取本院SLE合并TMA患者24例作为TMA组,单纯SLE无TMA患者48例作为SLE组,检测两组外周血ADAMT-13、CD154、sTM并分析其临床价值。结果TMA组外周血ADAMT-13低于SLE组,CD154、sTM高于SLE组(P<0.05);外周血ADAMT-13与SLEDAI评分呈负相关,CD154、sTM与SLEDAI评分呈正相关(P<0.05);外周血ADAMT-13、CD154、sTM均为SLE合并TMA的独立影响因素(P<0.05);外周血ADAMT-13、CD154、sTM联合诊断SLE合并TMA的曲线下面积(AUC)为0.941,大于各指标单独诊断。结论SLE合并TMA患者外周血ADAMT-13明显降低,CD154、sTM异常升高,各指标联合可为临床诊断SLE合并TMA提供重要参考。

Objective To explore the levels and clinical significance of von Willebrand factor cleavage protease(adamt)-13,B lymphocyte surface CD154 and soluble thrombomodulin(STM)in peripheral blood of patients with systemic lupus erythematosus(SLE)complicated with thrombotic microangiopathy(TMA).Methods Twenty-four patients with SLE and TMA in our hospital were selected as the TMA group,and 48 patients with SLE without TMA were selected as the SLE group.The expression of ADAMT-13,CD154 and sTM of peripheral blood from the two groups were detected and their clinical value was analyzed.Results The expression of ADAMT-13 in TMA group was lower than SLE group,CD154 and sTM were higher than SLE group(P<0.05),there were negatively correlated between ADAMT-13 and SLEDAI score,positively correlated among CD154,sTM and SLEDAI score(P<0.05),all ADAMT-13,CD154 and sTM were independent influencing factors in patients with SLE combined with TMA(P<0.05).ADAMT-13,CD154 and sTM combined diagnosis of SLE combined with TMA area under the curve(AUC)was 0.941,greater than each index in separate diagnosis.Conclusion The expressions of ADAMT-13 in peripheral blood of patients with SLE combined with TMA are significantly reduced,and CD154 and sTM are abnormally increased.All these cytokine may be an important indicators for clinical diagnosis of SLE combined with TMA.