Amezcua-Guerra Luis M, Springall Rashidi, Arrieta-Alvarado Angel A, Rodríguez Verónica, Rivera-Martinez Eduardo, Castillo-Martinez Diana, Bojalil Rafael
Department of Immunology and Microbiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Clin Lab. 2011;57(7-8):607-13.
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by tissue injury mediated by inflammatory mechanisms. Nonetheless, several acute-phase proteins may remain normal or are decreased. We explore the association of diverse biomarkers with selected clinical features, disease activity, and organ damage in SLE.
One hundred and fifteen SLE patients were analyzed for clinical manifestations, disease activity, and organ damage. Serum C-reactive protein (CRP), complement C3, C4 and CH50%, alpha-1-antitrypsin (AAT), transferrin (Tf), procalcitonin, erythrosedimentation rate (ESR), and interleukin-6 were measured in patients and twenty-six healthy blood donors. Statistics include chi-square, Kruskal-Wallis (post hoc by Mann-Whitney) or one-way ANOVA tests (post hoc by t tests) as appropriate. Associations were evaluated by the Spearman's correlation coefficient (p).
SLE patients have lower C3 (85 vs. 110 mg/dL; p < 0.0001) and C4 (14.2 vs. 24.2 mg/dL; p < 0.0001) than controls, while CRP (4.1 vs. 1.4 mg/L; p = 0.005) and AAT (147 vs. 138 mg/dL; p = 0.03) were higher, other biomarkers were irrelevant. Disease activity score positively correlated with ESR (p = 0.23, 95 % CI 0.04 to 0.4; p = 0.01) and CRP (p = 0.19, 0.0007 to 0.36; p = 0.04), while inverse correlations with C3 (p = -0.26, -0.43 to -0.08; p = 0.004), C4 (p = -0.18, -0.36 to 0.005; p = 0.04), CH50 % (p = -0.20, -0.38 to -0.01; p = 0.02), and Tf (p = -0.35, -0.53 to -0.12; p = 0.002) were found. According to clinical manifestations, patients with arthritis showed higher levels of ESR (34 vs. 20 mm/h), CRP (10 vs. 2.8 mg/L), and AAT (179 vs. 145 mg/dL), but lower Tf (192 vs. 226 mg/dL) than those without arthritis; whereas active nephritis was characterized by lower serum concentrations of complement C3 (73 vs. 92 mg/dL), C4 (10 vs. 15 mg/dL), CH50% (80 vs. 160 U/mL) and Tf (196 vs. 232 mg/dL) than those patients without this manifestation. No other significant differences were found.
In patients with SLE, acute-phase proteins behave differently depending on the kind of organ damage evaluated. Serum complement proteins remained as the most reliable laboratory markers for nephritis, while CRP was determined the best in patients with arthritis. The muted CRP response seen in SLE patients with active nephritis could have important pathogenic implications.
系统性红斑狼疮（SLE）是一种自身免疫性疾病，其特征是由炎症机制介导的组织损伤。尽管如此，几种急性期蛋白可能保持正常或降低。我们探讨了多种生物标志物与SLE患者特定临床特征、疾病活动度及器官损伤之间的关联。
分析115例SLE患者的临床表现、疾病活动度及器官损伤情况。检测患者及26名健康献血者血清中的C反应蛋白（CRP）、补体C3、C4及CH50%、α1抗胰蛋白酶（AAT）、转铁蛋白（Tf）、降钙素原、红细胞沉降率（ESR）及白细胞介素-6。统计学方法包括卡方检验、Kruskal-Wallis检验（事后用Mann-Whitney检验）或单因素方差分析（事后用t检验），视情况而定。通过Spearman相关系数（p）评估关联性。
SLE患者的C3（85 vs. 110mg/dL；p<0.0001）和C4（14.2 vs. 24.2mg/dL；p<0.0001）低于对照组，而CRP（4.1 vs. 1.4mg/L；p = 0.005）和AAT（147 vs. 138mg/dL；p = 0.03）较高，其他生物标志物无相关性。疾病活动评分与ESR（p = 0.23，95%CI 0.04至0.4；p = 0.01）和CRP（p = 0.19，0.0007至0.36；p = 0.04）呈正相关，而与C3（p = -0.26，-0.43至-0.08；p = 0.004）、C4（p = -0.18，-0.36至0.005；p = 0.04）、CH50%（p = -0.20，-0.38至-0.01；p = 0.02）和Tf（p = -0.35，-0.53至-0.12；p = 0.002）呈负相关。根据临床表现，有关节炎的患者ESR（34 vs. 20mm/h）、CRP（10 vs. 2.8mg/L）和AAT（179 vs. 145mg/dL）水平较高，但Tf（192 vs. 226mg/dL）低于无关节炎的患者；而活动性肾炎的特征是血清补体C3（73 vs. 92mg/dL）、C4（10 vs. 15mg/dL）、CH50%（80 vs. 160U/mL）和Tf（196 vs. 232mg/dL）浓度低于无此表现的患者。未发现其他显著差异。
在SLE患者中，急性期蛋白的表现因所评估的器官损伤类型而异。血清补体蛋白仍是肾炎最可靠的实验室标志物，而CRP在有关节炎的患者中表现最佳。活动性肾炎的SLE患者中CRP反应减弱可能具有重要的致病意义。
