多指标联合检测对老年系统性红斑狼疮患者肾脏血管内皮细胞损伤的诊断

Combined Detection of Multiple Indicators in the Diagnosis of Renal Vascular Endothelial Cell Injury in Older Patients with Systemic Lupus Erythematosus

目的探究血清可溶性血管细胞黏附分子-1(sVCAM-1)、抗内皮细胞抗体(AECA)、高迁移率族蛋白B1(HMGB1)联合检测在老年系统性红斑狼疮患者肾脏血管内皮细胞损伤中的诊断价值。方法采取前瞻性研究,选取2017年2月~2021年1月收治的120例老年系统性红斑狼疮患者作为观察组,其中肾功能异常患者45例为肾功能损害组,24 h尿蛋白定量≤0.5 g的75例患者为非肾功能损害组;另选取同期进行体检健康的志愿者120例作为对照组。比较观察组及对照组、有无肾功能损害组的血清sVCAM-1、AECA、HMGB1水平的差异,比较有无肾功能损害组的免疫功能,采用ROC曲线分析sVCAM-1、AECA、HMGB1对老年系统性红斑狼疮患者肾脏血管内皮细胞损伤的诊断意义。结果观察组sVCAM-1、AECA、HMGB1水平高于对照组(P<0.05)。肾功能损害组sVCAM-1、AECA、HMGB1水平高于非肾功能损害组(P<0.05),肾功能损害组补体C3、补体C4低于非肾功能损害组(P<0.05),免疫球蛋白(Ig)A、IgG高于非肾功能损害组(P<0.05)。通过ROC曲线分析得出sVCAM-1、AECA、HMGB1检测的临界值,采用并联模式(三者中有一项为阳性则判定是阳性)作为联合检测的方法,联合检测对肾功能损害的准确度及特异度最高。结论血清sVCAM-1、AECA、HMGB1联合检测在老年系统性红斑狼疮患者肾脏血管内皮细胞损伤的诊断中具有重要价值,可作为临床诊断的重要依据。

Objective To study the diagnostic value of serum soluble vascular cell adhesion molecule-1(sVCAM-1),anti-endothelial cell antibody(AECA)and high mobility group protein B1(HMGB1)in renal vascular endothelial cell injury in older patients with systemic lupus erythematosus(SLE).Methods A total of 120 older patients with SLE admitted to hospital from February 2017 to January 2021 were selected as the observation group.Among them,45 patients with 24-hour urinary protein quantification>0.5 g were assigned to the renal function impairment group,and 75 patients with 24-hour urinary protein quantification≤0.5 g were assigned to the non-renal function impairment group.Another 120 volunteers undergoing physical examination at the same time were selected as the control group.The levels of serum sVCAM-1,AECA and HMGB1 were compared between the observation group and control group,renal function impairment group and non-renal function impairment group.The immune function was compared between the renal function impairment group and non-renal function impairment group.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of sVCAM-1,AECA and HMGB1 in renal vascular endothelial cell damage in older patients with SLE.Results Compared with the control group,the observation group had higher levels of sVCAM-1,AECA and HMGB1(P<0.05).Compared with the non-renal function impairment group,the renal function impairment group had higher levels of sVCAM-1,AECA and HMGB1(P<0.05),lower levels of complement C3 and C4(P<0.05),and higher levels of IgA and IgG(P<0.05).The cut-off values of sVCAM-1,AECA and HMGB1 were obtained by ROC curve analysis.The parallel mode analysis showed that the combined detection had the highest accuracy and specificity for the diagnosis of renal function damage.Conclusion The combined detection of serum sVCAM-1,AECA and HMGB1 has important value in the diagnosis of renal vascular endothelial cell damage in older patients with SLE.