Vilá Luis M, Alarcón Graciela S, McGwin Gerald, Bastian Holly M, Fessler Barri J, Reveille John D
Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
J Rheumatol. 2005 Nov;32(11):2150-5.
To determine if different categories of erythrocyte sedimentation rate (ESR) elevation are associated with disease activity and/or damage in systemic lupus erythematosus (SLE).
We studied 2317 study visits in 553 SLE patients (> or = 4 American College of Rheumatology criteria, < or = 5 years' disease duration at enrollment) from a multiethnic (Hispanic, African American, and Caucasian) longitudinal study of outcome. A study visit was done every 6 months for the first year and annually thereafter. Erythrocyte sedimentation rate (ESR) was measured using the Westergren method; results were expressed in 4 categories: < 25 (normal), 25-50 (mild elevation), 51-75 (moderate elevation), and > 75 (marked elevation) mm/h. Anti-dsDNA antibodies were measured at enrollment with the Crithidia luciliae assay. Disease activity was assessed with the Systemic Lupus Activity Measure (SLAM) and the Physician's Global Assessment (PGA). Because ESR is one of the measures evaluated in the SLAM, it was excluded from the total SLAM score. Disease damage was assessed with the Systemic Lupus International Collaborating Clinics damage index (SDI). The relationship between the SLAM (total and PGA) and SDI scores (at baseline and for all visits) and anti-dsDNA antibodies (at enrollment) with ESR was examined by univariable and generalized estimating equation (GEE) regression analyses. Ethnicity, age, and sex were entered in all regression models.
The cohort consisted of 89.7% women with mean age 36.8 (SD 12.6) years and disease duration 4.6 (SD 3.2) years. GEE analyses showed that increasing levels of ESR and anti-dsDNA antibody positivity were independently associated with SLAM and PGA scores, at enrollment and for all visits. Overall, the associations of ESR with SLAM and PGA scores were stronger than for the presence of anti-dsDNA antibodies. At baseline, there was no relationship of ESR elevation or anti-dsDNA positivity with SDI scores. However, when all visits were studied, moderate and marked elevations of ESR were independently associated with SDI scores.
Mild, moderate, and marked ESR elevations are strongly associated with disease activity in SLE. Moderate and marked ESR elevations are also associated with damage accrual. These associations are stronger than those for the presence of anti-dsDNA antibodies. Our data suggest that ESR could be used to assess disease activity and predict organ/system damage in a relatively rapid and inexpensive manner in SLE.
确定红细胞沉降率（ESR）升高的不同类别是否与系统性红斑狼疮（SLE）的疾病活动和/或损伤相关。
我们对来自一项多民族（西班牙裔、非裔美国人和白种人）结局纵向研究的553例SLE患者（≥4条美国风湿病学会标准，入组时疾病病程≤5年）的2317次研究访视进行了研究。第一年每6个月进行一次研究访视，此后每年一次。采用魏氏法测量红细胞沉降率（ESR）；结果分为4类：<25（正常）、25 - 50（轻度升高）、51 - 75（中度升高）和>75（显著升高）mm/h。入组时用间接免疫荧光法检测抗双链DNA抗体。用系统性红斑狼疮活动度测量（SLAM）和医生整体评估（PGA）评估疾病活动度。由于ESR是SLAM中评估的指标之一，故将其从SLAM总分中排除。用系统性红斑狼疮国际协作临床损伤指数（SDI）评估疾病损伤。通过单变量和广义估计方程（GEE）回归分析，研究SLAM（总分和PGA）及SDI评分（基线和所有访视时）与抗双链DNA抗体（入组时）和ESR之间的关系。所有回归模型均纳入种族、年龄和性别因素。
该队列中女性占89.7%，平均年龄36.8（标准差12.6）岁，疾病病程4.6（标准差3.2）年。GEE分析表明，ESR水平升高和抗双链DNA抗体阳性在入组时和所有访视时均与SLAM和PGA评分独立相关。总体而言，ESR与SLAM和PGA评分的关联比抗双链DNA抗体阳性更强。在基线时，ESR升高或抗双链DNA阳性与SDI评分无关。然而，在研究所有访视时，ESR中度和显著升高与SDI评分独立相关。
ESR轻度、中度和显著升高与SLE疾病活动密切相关。ESR中度和显著升高也与损伤累积相关。这些关联比抗双链DNA抗体阳性更强。我们的数据表明，ESR可用于以相对快速和廉价的方式评估SLE的疾病活动并预测器官/系统损伤。
