胱抑素C及抗磷脂抗体与系统性红斑狼疮肾损伤病理类型的相关性

Correlation of cystatin C and antiphospholipid antibodies with pathological types of renal injury in patients with systemic lupus erythematosus

目的 探讨胱抑素C(CysC)、抗磷脂抗体及其他指标与系统性红斑狼疮(SLE)肾损伤病理类型的相关性,进一步研究SLE发生肾损伤的危险因素,为临床诊治提供依据。方法 选取75例单纯SLE患者和55例狼疮性肾炎(LN)患者,及同期到医院体检的健康对照者52例。行穿刺活检术的31例LN患者再分为LN-III/IV组19例和LN-II/V组12例。收集一般资料(D-二聚体、PLR、C3、C4、IgM、IgG、ESR、抗ds DNA抗体、Cysc、抗磷脂抗体、抗β2糖蛋白1抗体及肾脏穿刺病理资料)。比较Cysc等SLE疾病相关指标及抗磷脂抗体在三组之间的差异,探讨抗磷脂抗体与SLE肾损伤病理类型的相关性。结果 SLE组和LN组Cysc、IgG、PLR、D-二聚体、ESR、CRP水平高于健康对照组,C3、IgM、C4水平低于健康对照组,LN组Cysc水平高于SLE组,C3、IgG、IgM水平低于SLE组(P<0.05)。LN患者中抗β2糖蛋白1抗体、抗磷脂抗体的阳性率明显高于SLE患者(P<0.05)。LN-Ⅲ型/Ⅳ型组抗磷脂抗体(ACA)的阳性率较LN-Ⅱ/Ⅴ型组的显著升高(P=0.043)。CysC、C3、IgM、IgG是SLE发生肾损伤的危险因素。结论 抗磷脂抗体阳性可能提示肾损伤病理类型有更高的活动性,CysC、C3、IgM、IgG水平是SLE发生肾损伤的危险因素。

Objective To investigate the correlation of cystatin C(CysC),antiphospholipid antibodies(APL)and other indicators with systemic lupus erythematosus(SLE)and its pathological types of renal injury,and to further study the risk factors of renal injury in SLE,so as to provide evidence for clinical diagnosis and treatment.Methods A total of 75 patients with SLE and 55 patients with lupus nephritis(LN)were selected,and 52 healthy controls who visited the hospital for physical examination during the same period were selected.The 31 LN patients who underwent renal biopsy were further divided into two groups:19 cases in the LN-III/IV group and 12 cases in the LN-II/V group.General data including D-dimer,PLR,C3,C4,IgM,IgG,ESR,anti-double-stranded DNA antibody,CysC,anticardiolipin antibody,anti-β2-glycoprotein 1 antibody and renal biopsy pathological data were collected to compare the levels of serum Cystatin C and other systemic lupus erythematosus(SLE)-related indicators and antiphospholipid antibodies among the three groups,and to investigate the correlation between antiphospholipid antibodies and pathological types of renal injury in patients with SLE.Results The levels of CysC,IgG,PLR,D-dimer,ESR and CRP in the SLE group and the LN group were higher than those in the healthy control group,and the levels of C3,IgM and C4 were lower than those in the healthy control group.The level of CysC in the LN group was higher than that in the SLE group,the levels of C3,IgG and IgM were lower than those in the SLE group,and the differences were statistically significant(P<0.05).The positive rates of anti-β2-glycoprotein 1 antibody and anticardiolipin antibody in the LN patients were significantly higher than those in the SLE patients,with statistical significance(P<0.05).The positive rate of ACA in the LN-Ⅲ/Ⅳgroup was significantly higher than that in the LN-Ⅱ/Ⅴgroup(P=0.043).The levels of CysC,C3,IgM and IgG were the risk factors for renal injury in SLE.Conclusion Positive anticardiolipin antibodies may indicate a higher activity of renal injury.The levels of CysC,C3,IgM and IgG are the risk factors for renal injury in SLE.