Department of Internal Medicine 3, Division of Rheumatology and Clinical Immunology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology and Clinical Immunology Berlin-Buch, 13125, Berlin, Germany.
Clin Rheumatol. 2018 Jul;37(7):1835-1844. doi: 10.1007/s10067-018-4093-3. Epub 2018 Apr 14.
To examine disease activity parameters in patients with systemic lupus erythematosus (SLE) experiencing flare, infection, both, or neither condition, focusing on erythrocyte sedimentation rate (ESR). This study is a retrospective analysis of 371 consecutive inpatient SLE cases from 2006 to 2015. Cases were classified as flare (n = 147), infection (n = 48), both (n = 23), or neither (n = 135). ESR levels were correlated to C-reactive protein (CRP), ferritin, anti-dsDNA antibodies, complement C3 reduction, serositis, and erythrocyturia with proteinuria (Pearson's correlation). ESR levels were related to an age- and gender-adapted cut-off value (ESRp). We analyzed mean values of age, ESR, ESRp, CRP, ferritin and distribution of anti-dsDNA antibodies, C3 reduction, serositis, and erythrocyturia with proteinuria. Sensitivity and specificity were calculated via receiver operating characteristic or two-by-two table. Association of parameters with disease activity and infection was tested via two-sided chi square test. ESR correlated moderately with CRP in cases with flare and/or infection (r = 0.505-0.586). While ESR and CRP were normal in remission, mean values overlapped in cases with flare, infection, or both. ESRp was higher in flare than in infection (p = 0.048). ESR lost association to activity in infected cases, CRP to infection in flaring cases. ESRp, serositis, and anti-dsDNA antibodies were related to disease activity regardless of infections. Anti-dsDNA antibodies were most sensitive for detecting flares (74%), while serositis, proteinuria with erythrocyturia, anti-dsDNA antibodies, C3 reduction, and ESRp values ≥ 2 were most specific. ESR levels were raised by flares, infections, and age; adapting them to age and gender increased their diagnostic value. Obtaining several parameters remains necessary to differentiate flare from infection.
为了研究红斑狼疮（SLE）患者出现活动期、感染、二者兼有或二者皆无的情况下的疾病活动参数，重点关注红细胞沉降率（ESR）。本研究为 2006 年至 2015 年连续收治的 371 例住院 SLE 患者的回顾性分析。病例分为活动期（n=147）、感染（n=48）、二者兼有（n=23）或二者皆无（n=135）。ESR 水平与 C 反应蛋白（CRP）、铁蛋白、抗双链 DNA 抗体、补体 C3 降低、浆膜炎和血尿伴蛋白尿相关（Pearson 相关）。ESR 水平与年龄和性别调整的临界值（ESRp）相关。我们分析了年龄、ESR、ESRp、CRP、铁蛋白和抗双链 DNA 抗体、C3 降低、浆膜炎和血尿伴蛋白尿的分布的均值。通过接收者操作特征或四格表计算敏感性和特异性。通过双侧卡方检验检测参数与疾病活动和感染的相关性。ESR 与活动期和/或感染期的 CRP 中度相关（r=0.505-0.586）。在缓解期，ESR 和 CRP 正常，但在活动期、感染期或二者兼有时均值重叠。与感染期相比，活动期的 ESRp 更高（p=0.048）。在感染病例中，ESR 与活动期无关，CRP 与感染期无关。ESRp、浆膜炎和抗双链 DNA 抗体与疾病活动有关，与感染无关。抗双链 DNA 抗体检测活动期最敏感（74%），浆膜炎、血尿伴蛋白尿、抗双链 DNA 抗体、C3 降低和 ESRp 值≥2 特异性最高。ESR 水平因活动期、感染和年龄而升高；将其调整为年龄和性别会增加其诊断价值。获得多个参数对于区分活动期和感染仍然是必要的。
