ADA、CCL19在系统性红斑狼疮患者中的表达水平及临床意义

Expression of ADA and CCL19 in patients with systemic lupus erythematosus and its clinical significance

目的探讨血清腺苷脱氨酶(ADA)、趋化因子配体19(CCL19)在系统性红斑狼疮(SLE)患者中的表达水平及临床意义。方法选取2017年1月至2018年12月襄阳市中心医院收治的116例SLE患者为病例组,根据SLE活动度指数(SLEDAI)评分分为无活动组(n=37)、轻度活动组(n=32)、中度活动组(n=25)、重度活动组(n=22),并于同期随机选取40例襄阳市中心医院体检的健康志愿者为对照组。采用全自动生化分析仪检测治疗前后血清ADA水平,酶联免疫吸附法检测治疗前后血清CCL19水平。比较不同组别上述指标水平,Pearson积矩相关分析血清ADA、CCL19与SLEDAI评分的相关性,绘制受试者工作特征曲线(ROC曲线)评估其对SLE活动度的诊断价值及对预后的预测价值。结果病例组治疗前血清ADA、CCL19水平高于对照组,差异有统计学意义(P<0.05)。SLE患者治疗后血清ADA、CCL19水平低于治疗前(P<0.05);轻度活动组、中度活动组、重度活动组患者治疗前血清ADA、CCL19水平高于无活动组,中度活动组、重度活动组患者治疗前血清ADA、CCL19水平高于轻度活动组,重度活动组患者治疗前血清ADA、CCL19水平高于中度活动组,差异均有统计学意义(P<0.05);不同病情严重程度的SLE患者治疗后血清ADA、CCL19水平比较,差异无统计学意义(P>0.05)。SLE患者治疗前血清ADA、CCL19水平与SLEDAI评分呈正相关性(r=0.732、0.795,P<0.05)。ROC曲线结果显示,ADA诊断活动期SLE的AUC为0.820,截断值为22.04 U/L,约登指数为0.58,灵敏度、特异度分别为0.83、0.75;CCL19诊断的AUC为0.843,截断值为257.60 ng/L,约登指数为0.62,灵敏度、特异度分别为0.85、0.77;ADA联合CCL19诊断的AUC为0.893,约登指数为0.68,灵敏度、特异度分别为0.89、0.79。SLE患者出院后2年内,有49例患者复发(复发率42.24%),复发患者血清ADA、CCL19水平均高于未复发患者,差异有统计学意义(P<0.05)。ADA预测复发的AUC为0.799,截断值为47.18 U/L,约登指数为0.46,灵敏度、特异度分别为0.77、0.69;CCL19预测复发的AUC为0.807,截断值为479.58 ng/L,约登指数为0.51,灵敏度、特异度分别为0.79、0.72;ADA联合CCL19预测复发的AUC为0.865,约登指数为0.63,灵敏度、特异度分别为0.85、0.78。结论血清ADA、CCL19参与SLE的发病过程,并且与疾病严重程度呈正相关性,早期联合检测可作为临床辅助诊断SLE及评估病情严重性和预测预后的指标。

Objective To explore the expression levels of serum adenosine deaminase(ADA)and C-C chemokine ligand 19(CCL19)in patients with systemic lupus erythematosus(SLE)and its clinical significance.Methods A total of 116 patients with SLE admitted to Xiangyang Central Hospital from January 2017 to December 2018 were selected as case group,who were divided into non-activity group(n=37),mild activity group(n=32),moderate activity group(n=25)and severe activity group(n=22)according to the SLE disease activity index(SLEDAI).At the same time,40 healthy volunteers were randomly selected as control group.Serum ADA level before and after treatment was detected by automatic biochemical analyzer,and serum CCL19 level before and after treatment was measured by enzyme-linked immunosorbent assay.Pearson product moment correlation was used to analyze the association between serum ADA,CCL19 and SLEDAI score.The diagnostic value of ADA,CCL19 in SLE activity and prognostic value were evaluate by the ROC curve.Results The serum levels of ADA and CCL19 before treatment in case group were higher than those in control group,the difference was statistically significant(P<0.05).The serum levels of ADA and CCL19 before treatment in mild activity group,moderate activity group and severe activity group were higher than those in non-activity group,and which in moderate activity group and severe activity group were higher than those in mild activity group,and which in severe activity group were higher than those in moderate activity group,the difference was statistically significant(P<0.05).There was no significant difference on serum ADA and CCL19 levels after treatment between SLE patients with different severity(P>0.05).The serum ADA,CCL19 levels before treatment were positively associated with SLEDAI score(r=0.732,0.795;P<0.05).Drawing ROC curve showed that the AUC of ADA in diagnosis of active SLE was 0.820,the cut-off value was 22.04 U/L,the Youden index was 0.58,the sensitivity and specificity were 0.83 and 0.75 respectively.The AUC of CCL19 in diagnosis of active SLE was 0.843,the cut-off value was 257.60 ng/L,the Youden index was 0.62,the sensitivity and specificity were 0.85 and 0.77 respectively.The AUC of ADA combined with CCL19 was 0.893,the Youden index was 0.68,the sensitivity and specificity were 0.89 and 0.79 respectively.Within two years after discharge,49 patients relapsed(the recurrence rate was 42.24%).The serum ADA,CCL19 in patients with relapse were higher than those in patients without relapse,the difference was statistically significant(P<0.05).The AUC of ADA in predicting relapse was 0.799,the cut-off value was 47.18 U/L,the Youden index was 0.46,the sensitivity and specificity were 0.77 and 0.69 respectively.The AUC of CCL19 in predicting relapse was 0.807,the cut-off value was 479.58 ng/L,the Youden index was 0.51,the sensitivity and specificity were 0.79 and 0.72 respectively.The AUC of ADA combined with CCL19 in predicting relapse was 0.865,the Youden index was 0.63,the sensitivity and specificity were 0.85 and 0.78 respectively.Conclusion Serum ADA and CCL19 are involved in the pathogenesis of SLE,which are positively associated with severity of the disease.Early detection of ADA combined with CCL19 can be used as index for clinical auxiliary diagnosis,severity evaluation and prognosis prediction of SLE.