血清Gal-3水平与系统性红斑狼疮合并代谢综合征的相关性分析

发布时间：2018-08-04 13:13

【摘要】：目的系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种异质性自身免疫性疾病,其中自我耐受性紊乱导致固有免疫和适应性免疫功能失调,并出现多脏器损伤。与普通人群相比,SLE患者发生心血管疾病(cardiovascular disease,CVD)的风险增加了5至10倍,而在年轻患者中,这种风险甚至增加了50倍。SLE中CVD风险的增高是多因素所致的,包括传统的危险因素,炎症因素和疾病本身相关因素。代谢综合征(metabolic syndrome,MetS)是集一系列综合危险因素,包括高血压,向心性肥胖,空腹血糖异常和血脂异常于一身的代谢性疾病,其与普通人群CVD的发病率和死亡率增加高度相关。SLE患者中Met S的发生率较普通人群显著升高,并可能因此促成了患者体内早发动脉粥样硬化(atherosclerosis,AS)内环境的形成,从而显著增加了SLE患者发生CVD的风险。近来,半乳凝素3(galectin-3,Gal-3)在炎症反应,代谢与免疫紊乱发病机制中的作用受到了诸多的关注。一项基于社区的大样本横断面调查发现,循环Gal-3与MetS相关,但尚未在SLE患者中得到验证。此项研究旨在探讨SLE患者与普通人群间血清Gal-3水平的差异及其与SLE患者中MetS之间的关系。方法1.本研究于郑州大学第一附属医院风湿免疫科纳入符合2009年美国风湿病学院(American College of Rheumatology,ACR)关于SLE的分类标准的成年SLE患者80名,收集SLE患者的一般情况、临床特征资料以及实验室检查结果。于郑州大学第一附属医院体检中心随机选择健康志愿者80例作为对照组,收集一般情况与实验室检查结果。酶联免疫吸附法(enzyme-linked immuno sorbent assay,ELISA)检测血清中Gal-3的浓度。2.将SLE组分为两组:合并MetS者纳入SLE+MetS组;不合并MetS者纳入SLE-MetS组。将对照组分为两组:合并MetS者纳入MetS组;不合并Met S者纳入健康对照(Healthy Contral,HC)组。3.统计学比较SLE+MetS组与MetS组间疾病活动度,脏器损伤指数及药物使用情况,并分析Gal-3水平与SLE中MetS及其各组分的相关性。结果1.SLE组与对照组年龄、性别构成比无统计学差异。SLE组MetS发生率显著高于对照组(33.8%vs 16.3%,P0.05);SLE患者的血清Gal-3水平显著高于对照组,差异具有统计学意义(9.0±3.1 vs 6.6±1.8 ng/ml,P0.05)。2.SLE+MetS组患者血清Gal-3水平显著高于SLE-MetS组(10.5±3.3 vs 8.3±2.8 ng/ml,P0.05);SLE-MetS组血清Gal-3水平显著高于HC组(6.4±1.7 vs 8.3±2.8 ng/ml,P0.05);SLE+MetS组疾病活动指数(SLE Disease Activity Index,SLEDAI)及系统性狼疮国际协作组/美国风湿病学会脏器损伤指数(Systemic Lupus International Collaborating Clinc/American College of Rheumatology Damage Index,SDI)显著高于SLE-MetS组;SLE-MetS组羟氯喹(hydroxychloroquine,HCQ)使用比例显著高于SLE+MetS组,而两组间醋酸泼尼松目前使用剂量和累计使用剂量比较均无统计学差异。3.在SLE患者中,单变量logistic回归结果回示,Gal-3与MetS、高密度脂蛋白(high-density lipoprotein,HDL)、甘油三酯(triglycerides,TG)相关(OR=1.266,P=0.005;OR=1.056,P=0.031;OR=1.197,P=0.024),与血压(blood pressure,BP)和腰围(wasit circumference,WC)无明显相关性。排除年龄、性别、病程、BMI、SLEDAI评分、CRP、ESR、C3、C4、肾损害比例、醋酸泼尼松和羟氯喹使用情况等混杂因素(模型a)后,Gal-3与MetS、TG、HDL的相关性仍有统计学意义(OR=1.396,P=0.002;OR=1.243,P=0.020;OR=1.068,P=0.038)。结论(1)SLE患者血清Gal-3的水平较普通人群升高。(2)血清Gal-3的升高/降低与SLE患者MetS的发生相关。
[Abstract]:Objective systemic lupus erythematosus (systemic lupus erythematosus, SLE) is a heterogeneous autoimmune disease in which self tolerance disorder leads to innate and adaptive immune dysfunction and multiple organ damage. Compared with the general population, the risk of cardiovascular disease (CVD) in SLE patients is increased. 5 to 10 times, and in young patients, this risk even increased by 50 times.SLE CVD risk increased by multiple factors, including traditional risk factors, inflammatory factors and disease related factors. Metabolic syndrome (metabolic syndrome, MetS) is a set of combined risk factors, including hypertension, centripetal obesity, and fasting blood. Abnormal glucose and dyslipidemia in a body of metabolic disease, the incidence of CVD in the general population and the increase in mortality is highly correlated with the incidence of Met S in patients with.SLE significantly higher than the common population, and may thus contribute to the formation of the internal environment of early atherosclerosis (atherosclerosis, AS) in the patient's body, thus significantly increasing the SLE suffering. CVD risk. Recently, the role of hemagglutinin 3 (galectin-3, Gal-3) in the inflammatory response, metabolic and immune disorder mechanisms has attracted much attention. A large community based cross-sectional survey of large samples found that circulating Gal-3 is associated with MetS but has not been verified in SLE patients. This study aims to explore SLE patients and common people. The difference in serum Gal-3 level in the general population and the relationship with MetS in patients with SLE. Method 1. this study was conducted in the Department of Rheumatology at the First Affiliated Hospital of Zhengzhou University, which included 80 adult SLE patients who were in accordance with the classification criteria for SLE in the 2009 American rheumatology College (American College of Rheumatology, ACR), and collected the general situation of SLE patients. At the First Affiliated Hospital of Zhengzhou University, 80 healthy volunteers were randomly selected as the control group, and the general conditions and laboratory results were collected. The concentration of Gal-3 in serum.2. was detected by enzyme-linked immuno sorbent assay (ELISA) and the SLE group was divided into two groups. Group MetS was included in group SLE+MetS; no MetS was incorporated into group SLE-MetS. The control group was divided into two groups: the group of MetS was incorporated into the MetS group; no Met S was incorporated into the healthy control (Healthy Contral, HC) group. Results the correlation between MetS and its components in SLE. Results there was no statistical difference in age between 1.SLE and control group. The incidence of MetS in group.SLE was significantly higher than that of control group (33.8%vs 16.3%, P0.05); the serum Gal-3 level of SLE patients was significantly higher than that of the control group. The difference was statistically significant (9 + 3.1 vs 6.6 + 1.8 ng/ml, P0.05) The serum Gal-3 level was significantly higher than that in the SLE-MetS group (10.5 + 3.3 vs 8.3 + 2.8 ng/ml, P0.05), and the serum Gal-3 level in the SLE-MetS group was significantly higher than that in the HC group (6.4 + 1.7 vs 8.3 + 2.8 ng/ml, P0.05), and the SLE+MetS group disease activity index and the viscera damage index of the American Society for rheumatic diseases / American rheumatism society The stemic Lupus International Collaborating Clinc/American College of Rheumatology Damage Index, SDI) was significantly higher than that of the SLE-MetS group; the proportion of the use of hydroxychloroquine was significantly higher than that of the group, and there was no statistical difference between the current and cumulative dosage of the two groups. In SLE patients, the results of single variable logistic regression showed that Gal-3 and MetS, high-density lipoprotein (HDL), triglyceride (triglycerides, TG) related (OR=1.266, P=0.005, OR=1.056) and waist circumference were not significantly correlated with blood pressure and waist circumference. BMI, SLEDAI score, CRP, ESR, C3, C4, renal damage ratio, prednisone acetate and hydroxychloroquine use confounding factors (model a), Gal-3 and MetS, TG, HDL were still statistically significant (1) serum levels were higher than those of the general population. (2) serum (2) serum The increase / decrease of Gal-3 is associated with the occurrence of MetS in SLE patients.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.241;R589

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