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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (6): 1017-1022. doi: 10.19723/j.issn.1671-167X.2024.06.011

• 论著 • 上一篇    下一篇

系统性红斑狼疮疾病活动度相关特征分析及评估模型的构建

王红彦1, 李鑫铭2,3, 房柯池2,3, 朱华群1, 贾汝琳1,*(), 王晶2,3,*()   

  1. 1. 北京大学人民医院风湿免疫科，北京 100044
    2. 中国科学院心理研究所，中国科学院心理健康重点实验室，北京 100101
    3. 中国科学院大学心理学系，北京 100049
  • 收稿日期:2024-08-01 出版日期:2024-12-18 发布日期:2024-12-18
  • 通讯作者: 贾汝琳,王晶 E-mail:1036013457@qq.com;wangjing@psych.ac.cn
  • 作者简介:第一联系人：

    * These authors contributed equally to this work

  • 基金资助:
    国家自然科学基金(31970648)

Analysis of characteristics related to the disease activity of systemic lupus erythematosus and construction of an evaluation model

Hongyan WANG1, Xinming LI2,3, Kechi FANG2,3, Huaqun ZHU1, Rulin JIA1,*(), Jing WANG2,3,*()   

  1. 1. Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
    2. Institute of Psychology, Chinese Academy of Sciences; Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing 100101, China
    3. Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
  • Received:2024-08-01 Online:2024-12-18 Published:2024-12-18
  • Contact: Rulin JIA, Jing WANG E-mail:1036013457@qq.com;wangjing@psych.ac.cn
  • Supported by:
    the National Natural Science Foundation of China(31970648)

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摘要：

目的: 对系统性红斑狼疮(systemic lupus erythematosus, SLE)患者进行临床分层，分析不同活动度患者的临床特征，并探讨关键临床指标在SLE疾病活动度评估中的应用价值及评估模型的构建。方法: 回顾性分析1995年5月至2014年4月北京大学人民医院确诊的SLE患者临床资料。收集患者的人口学信息、临床表现、实验室检查结果，根据SLE疾病活动度指数2000(systemic lupus erythematosus disease activity index 2000, SLEDAI-2000)将患者分为疾病活动组与无疾病活动组。采用t检验、Mann-Whitney U检验以及χ2检验比较两组间差异，并使用Spearman相关性分析评估疾病活动组中与SLE活动度相关的临床指标。基于统计学分析结果，构建了逻辑回归模型，并对模型性能进行评估。结果: 两组在基本人口学特征上差异无统计学意义。疾病活动组中，抗核抗体(antinuclear antibodies，ANA)及抗双链DNA抗体(anti-double-stranded DNA antibodies，anti-dsDNA)阳性率升高；白细胞计数(white blood cell, WBC)、红细胞计数(red blood cell, RBC)、血红蛋白(hemoglobin, HGB)、淋巴细胞(lymphocytes, LY)、总蛋白(total protein, TP)、白蛋白(albumin, ALB)及补体C3水平显著降低，免疫球蛋白A(immunoglobulin A，IgA)、免疫球蛋白G(immunoglobulin G, IgG)水平明显升高。相关性分析结果显示，血红蛋白、白蛋白、补体C3和补体C4与其他临床指标相比具有更高的相关性指数，其中补体C3与疾病活动度具有一定负相关性。基于12项差异具有统计学意义的指标构建的逻辑回归模型准确率为91.4%，敏感性为94.4%，特异性为81.0%，受试者工作特征曲线(receiver operating characteristic, ROC)的线下面积(area under curve, AUC)为0.944。结论: 全面评估与SLE疾病活动度相关的临床指标，以实验室检查指标为主构建的逻辑回归模型能够较准确地评估SLE患者疾病活动度，为SLE患者的个体化治疗提供参考。

关键词: 系统性红斑狼疮, 临床分层, 疾病活动度, 临床指标

Abstract:

Objective: To stratify systemic lupus erythematosus (SLE) patients clinically, to analyze the clinical characteristics of patients with and without disease activity, and to explore the application va-lue of key clinical indicators in assessing disease activity, as well as to construct an evaluation model. Methods: A retrospective analysis was conducted on clinical data of the SLE patients diagnosed at Peking University People' s Hospital from May 1995 to April 2014. Demographic information, clinical manifestations, laboratory tests, and antibody detection results were collected. The patients were divided into active and inactive groups based on systemic lupus erythematosus disease activity index 2000(SLEDAI-2000)scores. t-tests, Mann-Whitney U tests, and χ2 tests were used to compare the differences between the groups. Spearman correlation analysis was used to evaluate the relevant clinical indicators associated with SLE activity in the active disease group. Based on the results of statistical analysis, a Logistic regression model was constructed, and the performance of the model was evaluated. Results: No significant differences were found in demographic characteristics between the two groups. In the active disease group, positive rates of antinuclear antibodies (ANA) and anti-double-stranded DNA antibodies (anti-dsDNA) were increased; white blood cell count (WBC), red blood cell count (RBC), hemoglobin (HGB), lymphocytes (LY), total protein (TP), albumin (ALB), and complement 3(C3) levels were significantly decreased; while immunoglobulin A and G levels were markedly elevated. The correlation analysis results showed that hemoglobin, albumin, C3, and complement 4(C4) had higher correlation indices compared with other clinical indicators. Among these, C3 exhibited a certain negative correlation with disease activity. The Logistic regression model based on 12 significantly different indicators (P < 0.05) achieved an accuracy of 91.4%, sensitivity of 94.4%, specificity of 81.0%, and the area under curve (AUC) of the receiver operating characteristic (ROC) was 0.944. Conclusion: This study comprehensively evaluated a range of clinical indicators related to SLE disease activity, providing a thorough understanding of both laboratory and clinical markers. The Logistic regression model, which was primarily constructed using laboratory test indicators, such as inflammatory markers, immune response parameters, and organ involvement metrics, demonstrated a high degree of accuracy in assessing the disease activity in SLE patients. Consequently, this model might provide a new basis for the diagnosis and treatment of SLE patients, offering significant clinical diagnostic value.

Key words: Systemic lupus erythematosus, Clinical stratification, Disease activity, Clinical indicators

中图分类号: 

  • R593.2

表1

有疾病活动组与无疾病活动组临床数据项对比"

Items No activity (n=71) Active (n=238) χ2/U/t P
Gender, n (%) 8 658.00 0.550
    Female 65 (91.55) 212 (89.08)
    Male 6 (8.45) 26 (10.92)
Onset age/years, M (P25, P75) 26 (21, 35) 28 (21, 38) 8 938.50 0.459
Family history, n (%) 3 (4.23) 21 (8.82) 8 837.50 0.205
Clinical manifestations, n (%) 60 (84.51) 227 (95.38) 10 331.50 0.004
Creatinine/(μmoI/L), M (P25, P75) 58.0 (45.5, 78.5) 57.0 (46.0, 74.0) 8 392.50 0.932
WBC/(×109/L), M (P25, P75) 7.10 (5.18, 10.35) 5.08 (3.36, 7.35) 5 282.00 < 0.001
RBC/(×1012/L), M (P25, P75) 3.68 (3.42, 4.11) 3.53 (2.98, 4.04) 6 981.00 0.017
Hemoglobin/(g/L), M (P25, P75) 113.7 (105.2, 127.0) 105.5 (90.1, 121.0) 6 321.50 < 0.001
Hematocrit/%, M ( P25, P75 ) 32.10 (0.39, 36.75) 27.80 (5.65, 34.48) 7 364.50 0.097
PLT/(×109/L), ${\bar x}$ ±s 160.83 ± 82.57 165.77 ± 94.02 0.40 0.688
Lymphocytes/(×109/L), M (P25, P75) 1.40 (1.00, 2.04) 1.00 (0.67, 1.40) 5 951.50 < 0.001
TP/(g/L), ${\bar x}$ ±s 67.62 ± 9.80 64.09 ± 13.12 -2.09 0.038
Albumin/(g/L), ${\bar x}$ ±s 39.29 ± 5.74 33.74 ± 6.87 -6.16 < 0.001
ANA, n (%) 46 (68.66) 194 (85.46) 10.96 0.001
Anti-dsDNA, n (%) 18 (27.27) 119 (55.35) 12.25 < 0.001
Anti-Ro/SS-A, n (%) 19 (12.86) 82 (36.60) 1.99 0.158
Anti-La/SS-B, n (%) 7 (10.00) 19 (8.56) 0.05 0.832
Anti-U1RNP, n (%) 17 (24.29) 66 (31.27) 0.15 0.703
Anti-Sm, n (%) 9 (12.86) 34 (15.38) 0.03 0.870
IgA/(g/L), M ( P25, P75) 2.35 (1.71, 2.91) 2.81 (2.07, 3.87) 8 598.50 0.004
IgG/(g/L), M (P25, P75) 12.7 (10.12, 17.7) 16 (10.93, 22.08) 10 302.00 0.014
IgM/(g/L), M (P25, P75 ) 0.98 (0.64, 1.57) 1.14 (0.71, 1.54) 10 071.00 0.258
C3/(g/L), M (P25, P75) 0.86 (0.61, 1.00) 0.51 (0.36, 0.75) 9 139.00 < 0.001
C4/(g/L), M (P25, P75) 0.16 (0.11, 0.21) 0.11 (0.06, 0.16) 7 017.00 0.345

图1

疾病活动组实验室检查项与SLEDAI-2000评分的相关性分析"

表2

疾病活动组实验室检查项与疾病活动度相关性分析"

Items r P
Anti-dsDNA 0.175 0.007
Clinical manifestations 0.174 0.008
ANA 0.106 0.104
Creatinine 0.010 0.127
IgA 0.061 0.356
IgM 0.057 0.381
Anti-U1RNP 0.011 0.869
Anti-Ro/SS-A 0.006 0.926
IgG 0.003 0.969
Anti-Sm -0.002 0.979
Anti-La/SS-B -0.052 0.432
Hematocrit -0.159 0.015
WBC -0.170 0.009
PLT -0.213 0.001
RBC -0.255 < 0.001
TP -0.259 < 0.001
Lymphocytes -0.279 < 0.001
Hemoglobin -0.313 < 0.001
Albumin -0.361 < 0.001
C4 -0.375 < 0.001
C3 -0.435 < 0.001

图2

逻辑回归模型ROC曲线"

表3

逻辑回归模型中各项指标权重系数"

Items w
Clinical manifestations -0.238
WBC 0.141
RBC -0.197
Hemoglobin 0.118
Lymphocytes 0.024
TP -0.275
Albumin 0.543
ANA-1 -0.134
ANA-2 0.000
ANA-3 0.108
ANA-4 0.253
ANA-5 -0.003
ANA-6 -0.009
ANA-7 -0.362
ANA-8 -0.105
ANA-9 -0.078
ANA-10 0.000
ANA-11 0.329
Anti-dsDNA-1 0.180
Anti-dsDNA-2 -0.180
IgA -0.033
IgG 0.040
C3 0.256
1 Barber MRW , Drenkard C , Falasinnu T , et al. Global epidemio-logy of systemic lupus erythematosus[J]. Nat Rev Rheumatol, 2021, 17 (9): 515- 532.
doi: 10.1038/s41584-021-00668-1
2 Schwartz N , Stock AD , Putterman C . Neuropsychiatric lupus: New mechanistic insights and future treatment directions[J]. Nat Rev Rheumatol, 2019, 15 (3): 137- 152.
doi: 10.1038/s41584-018-0156-8
3 Stamm TA , Bauernfeind B , Coenen M , et al. Concepts important to persons with systemic lupus erythematosus and their coverage by standard measures of disease activity and health status[J]. Arthritis Care Res (Hoboken), 2007, 57 (7): 1287- 1295.
doi: 10.1002/art.23013
4 Gladman DD , Ibañez D , Urowitz MB , et al. Systemic lupus erythematosus disease activity index 2000[J]. J Rheumatol, 2002, 29 (2): 288- 291.
5 Isenberg DA , Rahman A , Allen E , et al. BILAG 2004. Development and initial validation of an updated version of the British Isles Lupus Assessment Group's disease activity index for patients with systemic lupus erythematosus[J]. Rheumatology (Oxford), 2005, 44 (7): 902- 906.
doi: 10.1093/rheumatology/keh624
6 Sutton EJ , Davidson JE , Bruce IN . The systemic lupus international collaborating clinics (SLICC) damage index: A systematic literature review[J]. Semin Arthritis Rheum, 2013, 43 (3): 352- 361.
doi: 10.1016/j.semarthrit.2013.05.003
7 Emamikia S , Oon S , Gomez A , et al. Impact of remission and low disease activity on health-related quality of life in patients with systemic lupus erythematosus[J]. Rheumatology (Oxford), 2022, 61 (12): 4752- 4762.
doi: 10.1093/rheumatology/keac185
8 Wang Y , Han M , Pedigo CE , et al. Chinese herbal medicine for systemic lupus erythematosus: A systematic review and meta-analysis of randomized, placebo-controlled trials[J]. Chin J Integr Med, 2021, 27 (10): 778- 787.
doi: 10.1007/s11655-021-3497-0
9 Chen C , Wang L , Han B , et al. Autoimmune hemolytic anemia in hospitalized patients: 450 patients and their red blood cell transfusions[J]. Medicine (Baltimore), 2020, 99 (2): e18739.
doi: 10.1097/MD.0000000000018739
10 Yin X , Kim K , Suetsugu H , et al. Biological insights into syste-mic lupus erythematosus through an immune cell-specific transcriptome-wide association study[J]. Ann Rheum Dis, 2022, 81 (9): 1273- 1280.
doi: 10.1136/annrheumdis-2022-222345
11 Tobón GJ , Izquierdo JH , Cañas CA . B lymphocytes: Development, tolerance, and their role in autoimmunity-focus on systemic lupus erythematosus[J]. Autoimmune Dis, 2013, 2013 (1): 827254.
12 Wang Y , Xiao S , Xia Y , et al. The therapeutic strategies for SLE by targeting anti-dsDNA antibodies[J]. Clin Rev Allergy Immunol, 2022, 63 (2): 152- 165.
13 Qiu W , Yu T , Deng GM . The role of organ-deposited IgG in the pathogenesis of multi-organ and tissue damage in systemic lupus erythematosus[J]. Front Immunol, 2022, 13, 924766.
doi: 10.3389/fimmu.2022.924766
14 Lundtoft C , Sjöwall C , Rantapää-Dahlqvist S , et al. Strong association of combined genetic deficiencies in the classical complement pathway with risk of systemic lupus erythematosus and primary Sjögren' s syndrome[J]. Arthritis Rheumatol, 2022, 74 (11): 1842- 1850.
doi: 10.1002/art.42270
15 Jesus D , Rodrigues M , Matos A , et al. Performance of SLEDAI-2K to detect a clinically meaningful change in SLE disease activity: A 36-month prospective cohort study of 334 patients[J]. Lupus, 2019, 28 (5): 607- 612.
doi: 10.1177/0961203319836717
16 Koo M , Lu MC . Performance of a new instrument for the measurement of systemic lupus erythematosus disease activity: The SLE-DAS[J]. Medicina (Kaunas), 2023, 59 (12): 2097.
doi: 10.3390/medicina59122097
17 王蒙, 韩迪迪, 王力宁, 等. 系统性红斑狼疮两种评分系统对狼疮肾炎活动临床评价的比较[J]. 中华风湿病学杂志, 2016, 20 (6): 391- 395.
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