系统性红斑狼疮患儿治疗前血清MIF、MMP-9水平测定及其对预后的预测价值分析

Serum MIF and MMP-9 Levels before Treatment in Children with Systemic Lupus Erythematosus and Their Prognostic Values

目的 检测系统性红斑狼疮(SLE)患儿治疗前血清巨噬细胞移动抑制因子(MIF)、基质金属蛋白酶-9(MMP-9)的水平并分析其对患儿预后的预测价值。方法 选取2020年2月至2022年6月运城市中心医院收治的首诊SLE患儿126例,所有患儿均接受常规药物治疗并随访1年,随访期间观察患儿预后情况并根据有无器官损伤分为预后不良组(n=39)和预后良好组(n=87)。比较2组的基线资料、治疗前血清学指标[红细胞沉降率(ESR)、降钙素原(PCT)、C反应蛋白(CRP)、MIF、MMP-9]水平;Pearson相关分析患儿血清MIF与MMP-9水平的关系;Logistic回归分析SLE患儿预后的影响因素;绘制ROC及决策曲线分析治疗前血清MIF、MMP-9水平对SLE患儿预后的预测价值。结果 SLE患儿预后不良率为30.95%(39/126);2组患儿疾病活动度比较,差异有统计学意义(P<0.05)。预后不良组治疗前血清ESR、PCT、CRP及MIF、MMP-9水平均高于预后良好组(P<0.05)。血清MIF与MMP-9水平呈正相关(r=0.466,P<0.001);高疾病活动度、高水平ESR、PCT、CRP、MIF、MMP-9是SLE患儿预后不良的独立危险因素(OR>1,P<0.05);血清MIF、MMP-9水平单独及联合预测SLE患儿预后的AUC>0.70;阈值在0.0~1.0范围内血清MIF、MMP-9联合预测SLE患儿预后的净收益率>0。结论治疗前血清MIF、MMP-9水平在预后不良SLE患儿更高;二者可有效预测患儿预后,且联合预测的价值更高。

Objective To determine serum macrophage migration inhibitory factor(MIF) and matrix metalloproteinase-9(MMP-9) levels before treatment in children with systemic lupus erythematosus(SLE),and to analyze their prognostic values.Methods A total of 126 children with SLE who were diagnosed for the first time in Yuncheng Central Hospital from February 2020 to June 2022 were selected.All the children were treated with conventional drugs and followed up for 1 year.According to the presence or absence of organ damage,these children were divided into poor prognosis group(n=39) and good prognosis group(n=87).The baseline data and serological indexes [erythrocyte sedimentation rate(ESR),procalcitonin(PCT),C-reactive protein(CRP),MIF and MMP-9] were compared between the two groups.The relationship between serum MIF and MMP-9 levels was analyzed using Pearson's correlation analysis.Logistic regression analysis was used to test the influencing factors of prognosis.The ROC and decision curves were drawn to analyze the prognostic values of serum MIF and MMP-9 levels before treatment in children with SLE.Results The poor prognosis rate was 30.95 %(39/126).There was a significant difference in disease activity between the two groups(P<0.05).The levels of ESR,PCT,CRP,MIF and MMP-9 in the poor prognosis group were higher than those in the good prognosis group(P<0.05).The MIF level was positively correlated with the MMP-9 level(r=0.466,P<0.001).High disease activity and high levels of ESR,PCT,CRP,MIF and MMP-9 before treatment were independent risk factors for poor prognosis in children with SLE(OR>1,P<0.05).The AUCs of serum MIF and MMP-9 alone and in combination to predict the prognosis were >0.70.The combined prediction of serum MIF and MMP-9 within the threshold range of 0.0-1.0 had a net return rate of >0 for predicting the prognosis of SLE patients.Conclusion Serum MIF and MMP-9 levels before treatment are higher in SLE children with poor prognosis.Both MIF and MMP-9 can effectively predict the prognosis in SLE children.Especially,the combined prediction has a higher value.