血清ICAM-1、IL-6水平与系统性红斑狼疮患者疾病活动度的关系及评估颈动脉粥样硬化的价值

Relationship between serum ICAM-1,IL-6 levels and disease activity in patients with systemic lupus erythematosus and the value of evaluating carotid atherosclerosis

目的 研究血清细胞间黏附分子(ICAM-1)、白细胞介素-6(IL-6)与系统性红斑狼疮(SLE)患者疾病活动性的相关性,并探讨其评估颈动脉粥样硬化(CA)的临床价值。方法 回顾性选取2021年1月至2023年12月广西医科大学附属柳州市人民医院收治的SLE患者98例作为研究对象,设为SLE组。按SLE疾病活动指数(SLEDAI)-2000将其分为中重度活动(SLEDAI≥10分)组(n=53)与轻度活动(SLEDAI<10分)组(n=45);并按是否合并CA将患者分为CA组(n=29)与非CA组(n=69)。另选取同期健康体检者50名作为对照组。比较各组血清ICAM-1、IL-6水平,比较CA组与非CA组的临床资料[性别、年龄、体重指数、吸烟史、饮酒史、高血压、高脂血症、SLEDAI评分、C反应蛋白(CRP)、红细胞沉降率(ESR)、补体(C3、C4)],并使用多因素Logistic回归分析影响SLE并发CA的相关因素;用受试者操作特征(ROC)曲线评价血清ICAM-1、IL-6对SLE并发CA的评估能力。结果 SLE组血清ICAM-1、IL-6水平分别为(150.47±46.39)ng/mL、(21.54±5.49) pg/mL,均显著高于对照组[(65.52±19.46)ng/mL、(9.31±2.35) pg/mL],差异均有统计学意义(P<0.05)。中重度活动患者血清ICAM-1、IL-6水平分别为(177.41±42.36) ng/mL、(25.31±4.78) pg/mL,均显著高于轻度活动患者[(118.74±38.21) ng/mL、(17.10±4.23) pg/mL],差异均有统计学意义(P<0.05)。CA组合并高血压比例、SLEDAI评分、血清CRP、ICAM-1和IL-6水平分别为48.28%、(13.96±2.04)分、(4.36±1.42) mg/L、(171.58±38.41) ng/mL、(24.31±4.27) pg/mL,均高于非CA组[17.39%、(7.41±2.13)分、(3.72±1.19) mg/L、(141.60±42.34) ng/mL、(20.38±5.11) pg/mL],而补体C3、C4水平分别为(0.38±0.11)、(0.09±0.02)g/L,均低于非CA组[(0.57±0.16)、(0.14±0.04)g/L],差异均有统计学意义(P<0.05)。经Logistic回归分析得出,高血压、血清较高ICAM-1水平、较高IL-6水平均是患者并发CA的危险因素(OR=1.110,95%CI:1.016~1.212;OR=1.239,95%CI:1.078~1.424;OR=1.217,95%CI:1.079~1.371;P<0.05)。ROC曲线分析得出,血清ICAM-1、IL-6评估SLE并发CA的曲线下面积(AUC)分别为0.735、0.722,二者联合的AUC为0.810,相比单项指标显著增大(P<0.05)。结论 SLE患者血清ICAM-1、IL-6水平增高与疾病活动度相关,且对SLE并发CA有评估价值。

Objective To study the relationship between serum intercellular adhesion molecule-1(ICAM-1),interleukin-6(IL-6)and disease activity in patients with systemic lupus erythematosus(SLE),and to explore its clinical value in evaluating carotid atherosclerosis(CA).Methods A total of 98 patients with SLE admitted to Liuzhou People's Hospital Affiliated to Guangxi Medical University from January 2021 to December 2023 were retrospectively selected as the study subjects.They were set up as the SLE group.They were selected and divided into the moderate to severe activity group(SLEDAI≥10)(n=53)and the mild activity group(SLEDAI<10)(n=45)according to SLE disease activity index(SLEDAI)-2000.The patients were divided into CA group(n=29)and non-CA group(n=69)according to whether they were combined with CA.Another 50 healthy subjects were selected as the control group.The levels of serum ICAM-1 and IL-6 in each group were compared,The clinical data[gender,age,body mass index,smoking history,drinking history,hypertension,hyperlipidemia,SLEDAI score,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),complement(C3,C4)]were compared between CA group and non-CA group,and the related factors affecting SLE complicated with CA was analyze using Multivariate Logistic regression analysis.The ability of serum ICAM-1 and IL-6 to evaluate SLE complicated with CA was evaluated using the receiver operating characteristic(ROC)curve.Results The levels of serum ICAM-1 and IL-6 in SLE group were(150.47±46.39)ng/mL and(21.54±5.49)pg/mL,respectively,which were significantly higher than those in control group[(65.52±19.46)ng/mL and(9.31±2.35)pg/mL],and the differences were statistically significant(P<0.05).The levels of serum ICAM-1 and IL-6 in patients with moderate to severe activity were(177.41±42.36)ng/mL and(25.31±4.78)pg/mL,respectively,which were significantly higher than those in patients with mild activity[(118.74±38.21)ng/mL,(17.10±4.23)pg/mL],the differences were statistically significant(P<0.05).The proportion of hypertension,SLEDAI score,serum CRP,ICAM-1 and IL-6 levels in CA group were 48.28%,(13.96±2.04)points,(4.36±1.42)mg/L,(171.58±38.41)ng/mL and(24.31±4.27)pg/mL,respectively.They were higher than those in non-CA group[17.39%,(7.41±2.13)points,(3.72±1.19)mg/L,(141.60±42.34)ng mL,(20.38±5.11)pg/mL],while the levels of complement C3 and C4 were(0.38±0.11)and(0.09±0.02)g/L,respectively,which were lower than those in non-CA group[(0.57±0.16)and(0.14±0.04)g/L],the differences were statistically significant(P<0.05).Logistic regression analysis showed that hypertension,higher serum ICAM-1 level and higher IL-6 level were risk factors for CA(OR=1.110,95%CI:1.016-1.212;OR=1.239,95%CI:1.078-1.424;OR=1.217,95%CI:1.079-1.371;P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum ICAM-1 and IL-6 in evaluating SLE complicated with CA was 0.735 and 0.722,respectively,and the AUC of the combination of the two was 0.810,which was significantly higher than that of the single index(P<0.05).Conclusion The increase of serum ICAM-1 and IL-6 levels in SLE patients is related to disease activity,and has evaluation value for SLE complicated with CA.