C反应蛋白与系统性红斑狼疮的相关性

目的分析系统性红斑狼疮(systemic lupus erythemotosus,SLE)患者血清C反应蛋白(C-reactive protein,CRP)水平,了解SLE患者CRP与狼疮本身及合并感染的关系。方法对2009年1月至2011年5月北京大学第一医院住院SLE患者的病历进行回顾分析,研究SLE患者血清CRP水平与狼疮疾病活动度、器官受累的关系;并结合合并感染SLE患者血清CRP水平,探讨CRP对判定感染的敏感性及特异性。结果共入组283例SLE患者。在不合并感染的239例SLE患者中,血清CRP中位值为2.6 mgL,94.6%的患者CRP20.0 mgL。血液系统受累患者CRP水平高于无血液系统受累患者(3.2 mgL vs.2.0 mgL,P0.05),但合并浆膜炎、肾脏受累、关节炎的患者CRP水平与不合并上述表现的患者之间无显著性差异。在不同疾病活动度患者之间,CRP水平无显著差异(P0.05);但随着免疫抑制治疗患者疾病活动度降低,CRP、ESR水平均下降(P0.05)。合并感染SLE患者血清CRP水平明显高于不合并感染患者,差别具有统计学意义(13.6 mgL vs.2.6 mgL,P0.05),CRP21.3 mgL对于判断感染的特异性可达95.0%。结论不合并感染的SLE患者CRP水平多正常或轻度升高,免疫抑制治疗可以使患者CRP水平随病情改善而下降;血液系统受累患者CRP水平高于无血液系统受累患者。SLE患者合并感染时CRP水平可显著升高,故CRP可能作为临床上鉴别狼疮活动与感染的指标之一。

Relationship between C-reactive Protein and Systemic Lupus Erythemotosus

Objective The aim of this study was to investigate the levels of serum C-reactive protein （CRP） in patients with systemic lupus erythemotosus （SLE） , and furthermore the possible relationship between serum CRP and infection or SLE flare. Methods In-patients with SLE from Peking University First Hospital between 2009 January and 2011 May were enrolled and their clinical data were retrospectively analyzed. Results Totally 283 patients were enrolled. Most SLE patients without infection had normal CRP with the median level of 2. 6 mg/L. CRP level was found to be significantly higher in patients with hematological involvement than those without （3.2 mg/L vs. 2.0 mg/L, P 〈 0. 05 ）, but there were no difference between patients with serositis, lupus nephritis, arthritis and those without. Although no significant correlation was found between CRP levels and lupus disease activity （ P 〉 0.05 ） , the level of CRP as well as ESR was dramatically decreased after treatment （P 〈 0. 05 ）. CRP levels were significantly elevated in SLE patients with infection than those patients without infection （ 13.6 mg/L vs. 2. 6 mg/L, P 〈0. 05）. Taking 21.3 mg/Las a cut-off value, elevated CRP could predict infection in SLE patients with a specificity as high as 95.0%. Conclusions The serum CRP level is usually normal in lupus patients and is not correlated with disease activity, however, the CRP level is higher in SLE patients with hematological involvement and is significantly elevated in SLE patients with infection. Therefore serum CRP could be used as one of the serological markers to discriminate infection and SLE flare.