SLE患者慢性肾病的发生与血清抗核抗体荧光核型模式的相关性分析

Correlation between prognostic risk and serum antinuclear antibody specific fluorescence model in patients with SLE secondary chronic kidney disease

目的探讨系统性红斑狼疮(SLE)患者血清抗核抗体(ANA)荧光核型模式特征与发生慢性肾病的相关性。方法选取2019年1月至2022年11月绵阳市中心医院收治的SLE患者796例作为受试者,将其分为慢性肾脏病(CKD)组和非CKD组,CKD组再按照预后不同风险程度分为低风险组、中风险组、高风险组和极高风险组4组,分析不同组间受试者荧光核型模式特征和实验室资料,筛选与CKD发生进展相关的特异荧光核型模式。结果受试者总共检出ANA荧光核型模式13种,累计1563次。CKD组和非CKD组间性别和年龄比较,差异无统计学意义(P>0.05);组间肾小球滤过率(eGFR)和尿蛋白/肌酐比值(UACR)测定值、荧光核型叠加数量构成比、滴度构成比和核型类别构成比差异均有统计学意义(P<0.05);CKD组核均质型检出频数构成比显著高于非CKD组,而核斑点型、核仁型、致密颗粒型和其他胞浆型显著低于非CKD组,差异有统计学意义(P<0.05)。全体受试者中检出核均质型的受试者eGFR值更低,UACR更高;CKD组检出核均质型UACR值更高,差异均有统计学意义(P<0.05)。CKD患者按照预后风险高低分为4组,不同风险组间荧光核型叠加数量和核均质型检出构成比差异有统计学意义(P<0.05),高风险组和极高风险组核均质型占比显著高于低风险组,差异有统计学意义(P<0.05),CKD预后风险随叠加荧光核型数量和核均质型检出比例增加呈上升趋势。结论核均质型SLE患者更易发生慢性肾病,且预后更差,SLE患者慢性肾病的防治宜重视患者抗核抗体荧光核型模式特征的分析。

Objective To explore the correlation between the characteristics of serum antinuclear antibodies(ANA)fluorescence model and the prognostic risk of chronic kidney disease in SLE patients.Methods A total of 796 SLE patients in Mianyang Central Hospital from January 2019 to November 2022 were selected as subjects,and they were divided into Chronic kidney disease(CKD)group and non CKD group.CKD group was then grouped according to different risk levels of prognosis,including low risk group,medium risk group,high risk group,and extremly high risk group.The characteristics of fluorescent karyotype patterns and laboratory data of subjects in different groups were analyzed,and specific fluorescent karyotype patterns related to the occurrence and progress of CKD were screened.Results A total of 13 fluorescent karyotype patterns of ANA were detected by the subjects,with a total of 1563 times.There was no statistically significant difference in gender and age between the CKD group and the non CKD group(P>0.05);the differences in glomerular filtration rate(eGFR)and urinary protein/creatinine ratio(UACR)measurement values,fluorescence karyotype superposition quantity composition ratio,titer composition ratio,and karyotype category composition ratio between groups were statistically significant(P<0.05);the frequency composition of nuclear homogeneous type detection in the CKD group was significantly higher than that in the non CKD group,while nuclear spotted type,nucleolar type,dense granular type,and other cytoplasmic types were significantly lower than those in the non CKD group.Among all subjects,those with nuclear homogeneous type were found to have lower eGFR values and higher UACR;the CKD group detected a higher nuclear homogeneous UACR value,and the differences were statistically significant(P<0.05).CKD patients were divided into four groups based on their prognosis risk.There was a statistically significant difference in the number of fluorescent karyotypes superimposed and the proportion of nuclear homogeneous type detection between different risk groups,and the difference was statistically significant(P<0.05).The proportion of nuclear homogeneous type detection in the high-risk and extremely high-risk groups was significantly higher than that in the low-risk group,and the difference was statistically significant(P<0.05).The prognosis risk of CKD increased with the increase of the number of fluorescent karyotypes superimposed and the proportion of nuclear homogeneous type detection.Conclusion Patients with nuclear homogeneous SLE are more likely to develop CKD and have a higher risk of poor prognosis.More attention should be paid to the analysis of the characteristics of antinuclear antibody fluorescence model in the prevention and treatment of CKD in patients with SLE.