联合检测25羟基维生素D3、D-二聚体在狼疮性肾炎中的诊断价值

The Diagnostic Value of Combined Detection of 25-Hydroxyvitamin D3, D-Dimer in Lupus Nephritis

摘要: 目的：探讨系统性红斑狼疮(systemic lupus erythematosus, SLE)人群中血清25羟基维生素D3 [25-Hydroxyvitamin D3, 25-(OH)D3]、D-二聚体(D-dimer, D-D)联合检测对狼疮性肾炎的诊断价值，分析其在预测狼疮性肾炎(lupus nephritis, LN)发生风险中的应用价值。方法：选取2017年1月至2023年12月在济宁医学院附属医院风湿免疫科就诊的SLE患者，经筛选后最终纳入146例患者，检测患者25-(OH)D3、D-D。根据是否合并狼疮性肾炎将SLE患者分为合并狼疮性肾炎组(LN组) 46例与未合并狼疮性肾炎组(nLN组) 100例。通过Logistic回归分析诊断狼疮性肾炎的独立影响因素，分析相关性采用Spearman分析，受试者工作特征曲线(receiver operator characteristic, ROC)检测25-(OH)D3、D-D单独及联合检测对LN的应用价值。结果：1) LN组与nLN组：对两组之间SLEDAI评分、25-(OH)D3、D-D、HGB、C3、IgG、ESR进行比较，差异有统计学意义(P < 0.05)，而两组间性别、年龄、BMI、病程相比，差异无统计学意义(P > 0.05)。2) SLE合并LN的多因素二元Logistic回归分析：SLE合并LN的保护性因素有25-(OH)D3、IgG，危险因素有D-二聚体、SLEDAI评分。3) LN组各亚组：在三组中，通过相关性分析发现24小时尿蛋白定量与25-(OH)D3呈显著负相关(r = −0.297, P < 0.05)，与D-二聚体呈显著正相关(r = 0.350, P < 0.05)，中度组的25-(OH)D3水平低于轻度组，重度组的25-(OH)D3低于其余两组，差异有统计学意义(P < 0.05)。各亚组性别、年龄、病程、BMI、SLEDAI评分、D-D之间比较，差异无统计学意义(P > 0.05)。4) SLE患者不同疾病活动度组：相关性分析显示，SLEDAI评分与D-D呈显著正相关(r = −0.169, P < 0.05)，与25-(OH)D3呈负相关(r = 0.266, P < 0.05)；三组中，低疾病活动度组24 h尿蛋白定量最低，高疾病活动度组高于其余两组，三组间D-二聚体差异有统计学意义，在性别、年龄、病程、BMI、25-(OH)D3的差异无统计学意义(P > 0.05)。5) ROC曲线分析：25-(OH)D3、D-D单独及联合预测SLE合并LN的曲线下面积分别为0.708、0.679、0.750。结论：联合检测25-(OH)D3、D-D对狼疮性肾炎具有临床诊断价值。

Abstract: Objective: To explore the diagnostic value of combined detection of serum 25-Hydroxyvitamin D3 [25-(OH)D3] and D-dimer (D-D) in lupus nephritis (LN) among patients with systemic lupus erythematosus (SLE), and to analyze their application value in predicting the risk of LN occurrence. Methods: SLE patients who visited the Department of Rheumatology and Immunology at the Affiliated Hospital of Jining Medical University from January 2017 to December 2023 were selected. After screening, a total of 146 patients were finally included. The levels of 25-(OH)D3 and D-D were measured in these patients. Based on the presence or absence of lupus nephritis, the SLE patients were divided into two groups: the lupus nephritis group (LN group, 46 cases) and the non-lupus nephritis group (nLN group, 100 cases). Logistic regression analysis was used to identify independent influencing factors for the diagnosis of lupus nephritis. Spearman correlation analysis was performed to assess the relationships between variables. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic value of 25-(OH)D3, D-D alone, and in combination for LN. Results: 1) Comparison between LN and nLN Groups: Significant differences were observed in SLEDAI scores, 25-(OH)D3, D-D, HGB, C3, IgG, and ESR between the two groups (P < 0.05). However, no significant differences were found in gender, age, BMI, or disease duration between the groups (P > 0.05). 2) Multivariate Logistic Regression Analysis for SLE with LN: Protective factors for SLE with LN included 25-(OH)D3 and IgG, while risk factors included D-dimer and SLEDAI score. 3) Subgroup Analysis within the LN Group: Correlation analysis revealed that 24-hour urinary protein excretion was significantly negatively correlated with 25-(OH)D3 (r = −0.297, P < 0.05) and significantly positively correlated with D-dimer (r = 0.350, P < 0.05). The 25-(OH)D3 levels were lower in the moderate group compared to the mild group, and lower in the severe group compared to the other two groups (P < 0.05). No significant differences were found in gender, age, disease duration, BMI, SLEDAI scores, or D-D between the subgroups (P > 0.05). 4) Different Disease Activity Groups in SLE Patients: Correlation analysis showed that SLEDAI scores were significantly positively correlated with D-D (r = 0.169, P < 0.05) and negatively correlated with 25-(OH)D3 (r = −0.266, P < 0.05). Among the three groups, the low disease activity group had the lowest 24-hour urinary protein excretion, while the high disease activity group had higher levels than the other two groups. Significant differences in D-dimer levels were observed among the three groups, while no significant differences were found in gender, age, disease duration, BMI, or 25-(OH)D3 (P > 0.05). 5) ROC Curve Analysis: The areas under the ROC curves for 25-(OH)D3, D-D alone, and in combination for predicting SLE with LN were 0.708, 0.679, and 0.750, respectively. Conclusion: The combined detection of 25-(OH)D3 and D-D holds clinical diagnostic value for lupus nephritis.