血脂水平异常在狼疮肾炎并心血管损害患者中的表达及在疾病活动评估中的应用

Dyslipidemia in evaluation of inflammatory state and disease activity in lupus nephritis patients with cardiovascular damage

目的评估狼疮肾炎并心血管损害患者血脂水平异常及其与疾病活动性的关系。方法回顾性收集空军军医大学第二附属医院风湿免疫科2012年1月~2019年12月狼疮肾炎并心血管损害患者39例(住院病例),及同期进行体检的健康者39例,对其实验室检查、影像学检查及治疗用药进行统计分析。结果应用糖皮质激素治疗前,狼疮肾炎并心血管损害患者的甘油三酯(TG)水平明显高于对照组(2.0±1.4 vs.1.0±0.4)mmol/L(P<0.01),高密度脂蛋白胆固醇(HDL-C)水平较对照组明显减低(1.03±0.42 vs.1.31±0.23)mmol/L(P<0.01),两组间总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)水平比较无明显差异。狼疮肾炎并心血管损害患者TG水平与免疫球蛋白G(IgG)水平(r=-0.32,P<0.05)呈负相关,与补体C3水平(r=0.44,P<0.01)呈正相关。TG判断狼疮肾炎并心血管患者病情活动的的最佳界值为1.295(灵敏度为79.49%;特异度为76.92%),ROC曲线下面积为0.8261。HDL-C判断狼疮肾炎并心血管损害患者病情活动的的最佳界值为1.165(灵敏度为76.92%;特异度为74.36%),ROC曲线下面积为0.7794。结论狼疮肾炎并心血管损害患者的TG明显高于健康对照者,HDL-C明显低于健康对照者。TG和HDL-C可以预测狼疮肾炎并心血管损害患者的疾病活动性。

AIM To evaluate the prevalence of dyslipidemia in a lupus nephritis(LN)population with cardiovascular damage and its association with LN disease activity.METHODS A retrospective study enrolled 39 patients with LN and cardiovascular damage and 39 healthy individuals.Complete clinical and demographic characteristics of the patients were obtained at diagnosis before corticosteroid treatment from their medical records and similar data were extracted from the controls.Total cholesterol,triglyceride,LDL-C,HDL-C levels and their correlations with the disease activity were analyzed.RESULTS Prior to the corticosteroid therapy,TG was significantly higher and HDL-C was lower in patients with LN and cardiovascular damage than those in controls(2.0±1.4 vs.1.0±0.4,P<0.01;1.03±0.42 vs.1.31±0.23,P<0.01).TG was negatively correlated with IgG(r=-0.32,P<0.05)and positively correlated with C3(r=0.44,P<0.01).The AUC for TG was 0.8261(sensitivity 79.49%;specificity 76.92%),at a cut-off value of 1.295.The AUC for HDL-C was 0.7794(sensitivity 76.92%;specificity 74.36%),at a cut-off value of 1.165.CONCLUSION TG is significantly higher and HDL-C is lower in patients with LN and cardiovascular damage compared with those in controls.TG and HDL-C could predict the disease activity in patients with LN and cardiovascular damage.