外周血SII、PLR、NLR与狼疮性肾炎活动的相关研究

Correlation Study of Peripheral Blood SII, PLR, NLR and Lupus Nephritis Activity

摘要: 目的：本研究的目的是了解外周血系统性免疫性炎症指数(systemic immune-inflammation index, SII)、血小板与淋巴比率(platelet-to-lymphocyte ratio, PLR)、中性粒细胞与淋巴细胞比率(neutrophil-to- lymphocyte ratio, NLR)在狼疮性肾炎(lupus nephritis, LN)患者中的水平，并探讨其与LN疾病活动的关系。方法：本研究纳入2016年06月01日至2021年12月31日于青岛大学附属医院就诊符合美国风湿病学会(ACR)制定的SLE诊断标准并经肾活检病理诊断为LN的患者(117例)为研究对象。根据2019年SLE疾病活动指数SLEDAI 2K将LN患者分为轻度活动组(SLEDAI ≤ 9)与中重度活动组(SLEDAI > 9)。分析SII、PLR、NLR在两组间与疾病活动之间的相关性。结果：LN中重度活动组SII、PLR、NLR较轻度活动组下降(P < 0.05)，SLEDAI评分与SII (r = −0.27, P = 0.003)、PLR (r = −0.22, P = 0.019)负相关，与补体C3 (r = 0.53, P = 0.000)、C4 (r = 0.52, P = 0.000)正相关。此外，基于ROC曲线，SII、PLR联合血清白蛋白、C3、24小时尿蛋白定量预测LN活动的曲线下面积可达84.3%，敏感度和特异度为76%和84%。结论：SII、PLR与LN疾病活动相关，是评估LN疾病活动的潜在指标。

Abstract: Objective: The purpose of this study was to understand the peripheral blood systemic immune- in-flammation index (SII), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), levels in patients with lupus nephritis (LN), and to investigate their relationships with LN disease activity. Methods: Patients with lupus nephritis pathologically diagnosed by renal biopsy and met the diagnostic criteria for SLE set by the American College of Rheumatology (ACR) from June 1, 2016, to December 31, 2021, at the Affiliated Hospital of Qingdao University (117 cases) were included in this study. Patients with LN were divided into mild activity group (≤9) and moderate- to-severe ac-tivity group (>9) according to the 2019 Systemic Lupus Erythematosus Disease Activity Index SLEDAI-2K. Correlations between SII, PLR, NLR, and disease activity were analyzed. Results: SII, PLR, and NLR decreased in the moderate-to-severe activity group of LN compared with the mild activity group (P < 0.05), and SLEDAI scores were negatively correlated with SII (r = −0.27, P = 0.003) and PLR (r = −0.22, P = 0.019) and positively correlated with C3 (r = 0.53, P = 0.000) and C4 (r = 0.52, P = 0.000). In addition, based on the ROC curve, the area under the curve of SII, PLR combined with albumin, C3, and 24-hour urine protein quantification predicted LN activity up to 84.3% with the sensitivity of 76% and the specificity of 84%. Conclusion: SII and PLR are associated with LN disease activity, and they are potential indicators for assessing LN disease activity.