系统性红斑狼疮相关肺动脉高压患者的血小板分布宽度水平及其诊断价值
Platelet Distribution Width Level in Patients With Systemic Lupus Erythematosus-Associated Pulmonary Arterial Hypertension and Its Diagnostic Value.
作者信息
He Yuzhu, Yu Yikai, Hu Shaoxian
机构信息
Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Arch Rheumatol. 2020 Feb 7;35(3):394-400. doi: 10.46497/ArchRheumatol.2020.7791. eCollection 2020 Sep.
OBJECTIVES
This study aims to compare the platelet distribution width (PDW) level in patients with systemic lupus erythematosus-associated pulmonary arterial hypertension (SLE-PAH) with that in patients with systemic lupus erythematosus alone (SLE-non-PAH) and to evaluate the clinical value of the PDW level in the early diagnosis of SLE-PAH.
PATIENTS AND METHODS
We analyzed 80 SLE-PAH patients (1 males, 79 females; 34.9±12.3 years; range, 19 to 77 years) and 154 sex- and age-matched SLE-non-PAH patients (4 males, 150 females; mean age 36.7±12.4 years; range, 19 to 69 years) hospitalized between June 2011 and April 2018. All patients underwent transthoracic Doppler echocardiography within three months of inclusion in the study. Age, sex, disease course, currently prescribed medications, clinical manifestations, and past history were collected. Pulmonary artery systolic pressure, ejection fraction, white blood cell count, red blood cell count, hemoglobin, platelet count, PDW, mean platelet volume, erythrocyte sedimentation rate, complement 3 (C3), and C4 levels were also obtained.
RESULTS
The PDW level was higher in the SLE-PAH group than that in the SLE-non-PAH group (p=0.023). SLE patients were allocated into high systemic lupus erythematosus disease activity index (SLEDAI) group (SLEDAI score, ≥10) (n=121) or low SLEDAI group (SLEDAI score, <10) (n=113). The PDW level was significantly higher in the high SLEDAI group than that in the low SLEDAI group (p=0.030). The receiver operating characteristic curve was used to evaluate the clinical value of the PDW level in diagnosing PAH in SLE patients. The PDW level was valuable for diagnosing PAH in SLE patients [area under the curve (AUC)=0.591, p=0.023]. The optimal critical value of the PDW level was 14.55 fL. Under these conditions, the sensitivity, specificity, and Youden index were 57%, 63% and 0.20, respectively. For newly diagnosed patients, the PDW level had good diagnostic accuracy, with an AUC of 0.626 (p=0.037). The optimal critical value of the PDW level was 14.65 fL. Under these conditions, the sensitivity, specificity, and Youden index were 66%, 67% and 0.33, respectively.
CONCLUSION
The PDW level is a good predictor of SLE-PAH, and this parameter is applicable to various clinical settings.
目的
本研究旨在比较系统性红斑狼疮相关肺动脉高压（SLE-PAH）患者与单纯系统性红斑狼疮（SLE-非PAH）患者的血小板分布宽度（PDW）水平，并评估PDW水平在SLE-PAH早期诊断中的临床价值。
患者与方法
我们分析了2011年6月至2018年4月期间住院的80例SLE-PAH患者（1例男性，79例女性；年龄34.9±12.3岁；范围19至77岁）和154例性别及年龄匹配的SLE-非PAH患者（4例男性，150例女性；平均年龄36.7±12.4岁；范围19至69岁）。所有患者在纳入研究的三个月内均接受了经胸多普勒超声心动图检查。收集了年龄、性别、病程、当前使用的药物、临床表现和既往史。还获取了肺动脉收缩压、射血分数、白细胞计数、红细胞计数、血红蛋白、血小板计数、PDW、平均血小板体积、红细胞沉降率、补体3（C3）和C4水平。
结果
SLE-PAH组的PDW水平高于SLE-非PAH组（p=0.023）。SLE患者被分为高系统性红斑狼疮疾病活动指数（SLEDAI）组（SLEDAI评分≥10）（n=121）或低SLEDAI组（SLEDAI评分<10）（n=113）。高SLEDAI组的PDW水平显著高于低SLEDAI组（p=0.030）。采用受试者工作特征曲线评估PDW水平在SLE患者中诊断PAH的临床价值。PDW水平对SLE患者诊断PAH有价值[曲线下面积（AUC）=0.591，p=0.023]。PDW水平的最佳临界值为14.55 fL。在此条件下，敏感性、特异性和尤登指数分别为57%、63%和0.20。对于新诊断的患者，PDW水平具有良好的诊断准确性，AUC为0.626（p=0.037）。PDW水平的最佳临界值为14.65 fL。在此条件下，敏感性、特异性和尤登指数分别为66%、67%和0.33。
结论
PDW水平是SLE-PAH的良好预测指标，该参数适用于各种临床情况。
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