Predescu Oana Raluca, Vreju Ananu Florentin, Dinescu Ștefan Cristian, Florescu Alesandra, Bita Cristina Elena, Mușetescu Anca Emanuela, Barbulescu Andreea Lili, Ciurea Paulina Lucia
Doctoral School of the University of Medicine and Pharmacy of Craiova, Romania.
Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Romania.
Curr Health Sci J. 2024 Jul-Sep;50(3):347-352. doi: 10.12865/CHSJ.50.03.01. Epub 2024 Sep 30.
The study has as main objective the evaluation of the potential roles of vitamin D, the neutrophil to lymphocyte ratio (NLR), and the systemic inflammation index (SII) as future biomarkers regarding the classification of flares in systemic lupus erythematosus (SLE).
Individuals diagnosed with SLE were encompassed in this observational study. The current applicable criteria, namely The European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) 2019 criteria had to be fulfilled. The participants underwent specific musculoskeletal examination, paraclinical investigations including complete blood count (CBC), determination of serum creatinine levels, as well as liver enzymes, and also the markers of inflammation. The fractions of the serum complement (C3 and C4) were also evaluated, together with serum vitamin D concentrations. Safety of Estrogens in Lupus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) was required in order to analyze the research group's disease activity.
NLR and SII demonstrated validity, having statistically significant correlations with SELENA-SLEDAI (p value less than 0.001). The ROC analysis proved a strong discriminative power for NLR (AUC=0.96) and SII (AUC=0.963) in predicting severe disease flares. Optimal cut-off values were 3.45 for NLR and 877,002.19 for SII. Serum vitamin D concentrations had a weak association with the SLEDAI score (p=0.048, r=0.213).
NLR and SII can be considered reliable biomarkers for discriminating between the levels of disease activity in SLE individuals. Low serum levels of vitamin D may also influence disease severity, but require further validation.
本研究的主要目的是评估维生素D、中性粒细胞与淋巴细胞比值（NLR）和全身炎症指数（SII）作为系统性红斑狼疮（SLE）病情发作分类未来生物标志物的潜在作用。
本观察性研究纳入了诊断为SLE的个体。必须满足当前适用的标准，即2019年欧洲抗风湿病联盟（EULAR）/美国风湿病学会（ACR）标准。参与者接受了特定的肌肉骨骼检查、包括全血细胞计数（CBC）、血清肌酐水平测定、肝酶以及炎症标志物在内的辅助临床检查。还评估了血清补体（C3和C4）分数以及血清维生素D浓度。为了分析研究组的疾病活动情况，需要使用狼疮国家评估-系统性红斑狼疮疾病活动指数（SELENA-SLEDAI）评估雌激素安全性。
NLR和SII显示出有效性，与SELENA-SLEDAI具有统计学显著相关性（p值小于0.001）。ROC分析证明NLR（AUC=0.96）和SII（AUC=0.963）在预测严重疾病发作方面具有很强的判别能力。NLR的最佳截断值为3.45，SII的最佳截断值为877,002.19。血清维生素D浓度与SLEDAI评分的关联较弱（p=0.048，r=0.213）。
NLR和SII可被视为区分SLE个体疾病活动水平的可靠生物标志物。血清维生素D水平低也可能影响疾病严重程度，但需要进一步验证。
