抗磷脂抗体在狼疮性肾炎中的意义。

Significance of antiphospholipid antibodies in lupus nephritis.

作者信息

Natejumnong Chindarat, Ruangkanchanasetr Prajej, Aimpun Pote, Supaporn Thanom

机构信息

Division of Nephrology, Phramongkutklao Hospital, Bangkok, Thailand.

出版信息

J Med Assoc Thai. 2006 Aug;89 Suppl 2:S121-8.

PMID:17044463

Abstract

BACKGROUND

Some autoantibodies have been associated with lupus nephritis but the role of antiphospholipid antibodies (APA) is controversial.

OBJECTIVE

The present study was to explore the role of APA by comparing demographic profiles and the presence of anticardiolipin antibody (aCL) and lupus anticoagulant (LA) in systemiclupus erythematosus 1 (SLE) patients with and without nephritis.

MATERIAL AND METHOD

The cross-sectional study in a tertiary center was conducted in 77 SLE patients. All patients attended our renal or rheumatology clinics between June 2002 and December 2003.

RESULTS

Sixty-three (82%) of the 77 SLE patients had nephritis. The prevalence of antiphospholipid syndrome (APS) was 10% (8 patients), positive aCL (IgG) was 26% (20 patients) and positive LA was 26% (20 patients). The receiver operating characteristic (ROC) method was applied to assess the significance of aCL in both nephritis and non-nephritis groups. Area under the ROC curve was 0.538 (95%CI 0.312-0.765), a cutoff value of 20.5 GPL had a sensitivity of 75% and a specificity of 53%. In univariate analysis, neither positivity for anticardiolipin antibody nor lupus anticoagulant was associated with lupus nephritis. Analyzed in only the lupus nephritis group, LA-positive lupus nephritis patients had higher systolic blood pressure (SBP) (133.7 vs 121.9 mmHg, p = 0.005), lower platelet count (209.8 vs 264.4 x 10(3)/microL, p = 0.02) and higher 24-hr urine protein excretion (2.6 vs 1.4 g, p = 0.02) than LA-negative lupus nephritis patients. Serum creatinine was higher in LA-positive lupus nephritis than LA-negative (233.0 vs 94.9 micromol/L), but did not reach statistical significance.

CONCLUSION

APA are frequently seen in SLE patients, but not associated with lupus nephritis. However lupus anticoagulant tends to associate with lupus nephritis. Detection of LA in lupus nephritis patients could identify patients who had increased risk to develop bad renal outcomes (elevated SBP and 24-hr urine protein excretion).

摘要

背景

一些自身抗体与狼疮性肾炎相关，但抗磷脂抗体（APA）的作用存在争议。

目的

本研究旨在通过比较有肾炎和无肾炎的系统性红斑狼疮1（SLE）患者的人口统计学特征以及抗心磷脂抗体（aCL）和狼疮抗凝物（LA）的存在情况，探讨APA的作用。

材料与方法

在一家三级中心对77例SLE患者进行了横断面研究。所有患者于2002年6月至2003年12月期间就诊于我们的肾脏或风湿病诊所。

结果

77例SLE患者中有63例（82%）患有肾炎。抗磷脂综合征（APS）的患病率为10%（8例患者），aCL（IgG）阳性率为26%（20例患者），LA阳性率为26%（20例患者）。采用受试者工作特征（ROC）方法评估aCL在肾炎组和非肾炎组中的意义。ROC曲线下面积为0.538（95%CI 0.312 - 0.765），临界值20.5 GPL时，敏感性为75%，特异性为53%。在单因素分析中，抗心磷脂抗体阳性和狼疮抗凝物阳性均与狼疮性肾炎无关。仅在狼疮性肾炎组中分析，LA阳性的狼疮性肾炎患者收缩压（SBP）较高（133.7 vs 121.9 mmHg，p = 0.005），血小板计数较低（209.8 vs 264.4×10³/μL，p = 0.02），24小时尿蛋白排泄量较高（2.6 vs 1.4 g，p = 0.02），高于LA阴性的狼疮性肾炎患者。LA阳性的狼疮性肾炎患者血清肌酐高于LA阴性患者（233.0 vs 94.9 μmol/L），但未达到统计学意义。