FIB/ALB与系统性红斑狼疮活动性的相关性分析和对预后的预测价值

Correlation analysis between fibrinogen/albumin ratio and systemic lupus erythematosus activity and its predictive value for prognosis

目的探讨纤维蛋白原(FIB)/血清白蛋白(ALB)比值(FAR)与系统性红斑狼疮(SLE)活动性的相关性及对预后的预测价值。方法选择2020年1月至2023年10月湖州市第一人民医院门诊及住院治疗的活动期SLE患者67例,并选择同期稳定期SLE患者36例进行队列研究。收集所有患者性别、年龄、病程、SLE疾病活动指数(SLEDAI)评分、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、乳酸脱氢酶(LDH)、血清α-羟丁酸脱氢酶(α-HBDH)、三酰甘油(TG)、总胆固醇(TC)、FIB、ALB、补体C3、补体C4、免疫球蛋白、尿微量ALB、肌酐(Cr)等结果进行统计分析;通过出院后定期进行电话随访,分析FAR对SLE疾病不良预后的预测价值。结果SLE患者SLE疾病活动指数评分(SLEDAI)、LDH、α-HBDH、TG、FIB、FAR、尿微量ALB/肌酐(Cr)(ACR)均高于稳定期患者[(13.64±4.49)分比(2.80±1.60)分,(269.37±85.02)U/L比(158.53±64.10)U/L,(186.44±35.76)U/L比(163.72±30.94)U/L,(2.87±0.71)mmol/L比(2.48±0.68)mmol/L,(3846.92±972.57)mg/L比(2958.63±991.43)mg/L,(91.77±22.07)mg/g比(75.30±11.63)mg/g,(52.97±29.30)mg/g比(33.89±20.26)mg/g],ALB、补体C3均低于稳定期患者[(38.42±4.58)g/L比(41.11±4.26)g/L,(0.61±0.22)g/L比(0.79±0.28)g/L],差异均有统计学意义(t=-13.96、6.84、-3.21、-2.69、-4.39、-4.17、-3.48、2.91、3.42,均P<0.05)。纠正混杂因素前,FIB、ALB、FAR均为活动性SLE的影响因素,OR值分别为1.001、0.808、1.053;纠正混杂因素后,FIB、FAR仍然为活动性SLE影响因素,OR值分别为1.001、1.050。FIB、ALB、FAR预测活动性SLE的受试者工作特征曲线下面积(AUC)分别为0.707、0.699、0.769,且FAR对活动性SLE的预测价值高于FIB、ALB,差异有统计学意义(P<0.05)。FAR、FIB、ALB与SLEDAI相关系数(r)分别为0.405、0.389、-0.319。FAR预测活动性SLE不良预后的AUC为0.734(0.614~0.853),最佳截断值为97.50 mg/g。结论FAR对活动性SLE及不良预后SLE有较高的预测价值,且为活动性SLE的影响因素。

Objective To investigate the correlation between fibrinogen(FIB)/albumin(ALB)ratio(FAR)and active systemic lupus erythematosus(SLE),and its predictive value for prognosis.Methods Sixty-seven patients with active SLE who underwent outpatient and inpatient treatment at The First People's Hospital of Huzhou from January 2020 to October 2023 were included in this study.Another 36 patients with stable SLE who concurrently received treatment were chosen for a cohort study.Sex,age,duration of the disease,SLE disease activity index score,aspartate aminotransferase,alanine transaminase,lactate dehydrogenase,serumα-hydroxybutyrate dehydrogenase,triglycerides,total cholesterol,FIB,ALB,complement C3,complement C4,immunoglobulins,urinary trace ALB,creatinine,and other relevant data were statistically analyzed.Additionally,the predictive value of FAR for a poor prognosis in SLE was analyzed through regular telephone follow-ups after discharge.Results SLE disease activity index score,lactate dehydrogenase,α-hydroxybutyrate dehydrogenase,triglycerides,FIB,FAR,and urinary microalbumin/creatinine were all higher in active SLE patients than stable phase patients[(13.64±4.49)scores vs.(2.80±1.60)scores,(269.37±85.02)U/L vs.(158.53±64.10)U/L,(186.44±35.76)U/L vs.(163.72±30.94)U/L,(2.87±0.71)mmol/L vs.(2.48±0.68)mmol/L,(3846.92±972.57)mg/L vs.(2958.63±991.43)mg/L,(91.77±22.07)mg/g vs.(75.30±11.63)mg/g,(52.97±29.30)mg/g vs.(33.89±20.26)mg/g],while ALB and complement C3 were lower in active SLE patients than stable phase patients[(38.42±4.58)g/L vs.(41.11±4.26)g/L,(0.61±0.22)g/L vs.(0.79±0.28)g/L],and the differences were statistically significant(t=-13.96,6.84,-3.21,-2.69,-4.39,-4.17,-3.48,2.91,3.42,all P<0.05).Before correcting for confounding factors,FIB,ALB,and FAR were all influencing factors for active SLE,with odds ratio values of 1.001,0.808,and 1.053,respectively.After correcting for confounding factors,FIB and FAR remained influencing factors for active SLE,with odds ratio values of 1.001 and 1.050,respectively.The area under the receiver operating characteristic curve of FIB,ALB,and FAR for predicting active SLE were 0.707,0.699,and 0.769,respectively,while the predictive value of FAR for active SLE was significantly higher than that of FIB and ALB(P<0.05).The correlation coefficients(r)between FAR,FIB,ALB and SLE disease activity index were 0.405,0.389,and-0.319,respectively.The area under the receiver operating characteristic curve of FAR for predicting poor prognosis of active SLE was 0.734(0.614-0.853),with an optimal cutoff value of 97.50 mg/g.Conclusions FAR has a high predictive value for active SLE and poor prognosis SLE,and it is an influencing factor for active SLE.