系统性红斑狼疮患者妊娠期血清CCL19和sCD163水平及其对母婴结局的影响

Expression levels of serum CCL19 and sCD163 in patients with systemic lupus erythematosus during pregnancy and their impact on maternal and infant outcomes

摘要

目的 探讨外周血趋化因子配体19（CCL19）和可溶性CD163（sCD163）在系统性红斑狼疮（SLE）患者妊娠期血清中的水平变化，并阐明其对母婴结局的影响。 方法 选取180例妊娠期SLE患者作为SLE组，根据母婴结局分为妊娠成功组（n=132）和妊娠失败组（n=48）；另外随机选取同期产检的180例健康孕妇作为对照组。收集2组研究对象一般资料，试剂盒检测2组研究对象血清中CCL19和sCD163水平及相关血清因子水平。采用多因素Logistic回归分析检测SLE患者妊娠失败的影响因素，受试者工作特征（ROC）曲线分析SLE组血清中CCL19和sCD163水平预测妊娠结局的效果。 结果 与对照组比较，SLE组患者血清中补体C3和补体C4水平明显降低（P<0.05），血清中红细胞沉降率（ESR）、肌酐（CR）、抗心磷脂抗体（ACA）-IgG、抗β2糖蛋白Ⅰ（anti-β2GPⅠ）、CCL19和sCD163水平明显升高（P<0.01）。与妊娠成功组比较，妊娠失败组患者血清中补体C3和补体C4水平明显降低（P<0.01），血清中ESR、CR、ACA-IgG、anti-β2GPⅠ、CCL19和sCD163水平均明显升高（P<0.01）。血清中CCL19、sCD163、ESR、CR、ACA-IgG和anti-β2GPⅠ水平是妊娠期SLE患者妊娠失败的危险因素（P<0.05或P<0.01），补体C3和补体C4水平是妊娠期SLE患者妊娠失败的保护因素（P<0.01）。血清CCL19水平预测妊娠期SLE患者妊娠失败的ROC曲线下面积（AUC）为0.726，血清sCD163水平预测妊娠期SLE患者妊娠失败预后的AUC为0.789，二者联合预测妊娠期SLE患者妊娠失败的AUC为0.835。二者联合预测妊娠期SLE患者妊娠失败的效能优于CCL19和sCD163水平各自单独预测（Z_{联合检测-CCL19}=3.066，P=0.002；Z_{联合检测-sCD163}=2.087，P=0.037）。 结论 SLE患者妊娠期血清中CCL19和sCD163水平明显升高，可能导致患者母婴结局不良。

Abstract

Objective To discuss the changes in the levels of chemokine ligand 19 （CCL19） and soluble CD163 （sCD163） in serum of the patients with systemic lupus erythematosus （SLE） during pregnancy， and to clarify their effects on the maternal and infant outcomes. Methods A total of 180 pregnant SLE patients were selected as SLE group and then divided into successful pregnancy group （n=132） and pregnancy failure group （n=48） based on the maternal and infant outcomes. A total of 180 healthy pregnant women underwent prenatal checks during the same period were randomly selected as control group. The general data of the patients in two groups were collected， and the serum levels of CCL19 and sCD163， along with related serum factors， were detected by kits. Multivariate Logistic regression analysis was used to detect the risk factors for pregnancy failure in the SLE patients， and receiver operating characteristic （ROC） curve was used to evaluate the effectiveness of serum CCL19 and sCD163 levels in predicting the pregnancy outcomes of the patients in SLE group. Results Compared with control group， the levels of complements C3 and C4 in the serum of the patients in SLE group were significantly decreased （P<0.05）， and the levels of erythrocyte sedimentation rate （ESR）， creatinine （CR）， anti-cardiolipin antibody （ACA）-IgG， anti-β2 glycoprotein Ⅰ （anti-β2GPⅠ）， CCL19， and sCD163 of the patients were significantly increased （P<0.01）. Compared with successful pregnancy group， the levels of complement C3 and C4 pregnancy of the patients in failure group were significantly decreased （P<0.01）， and the levels of ESR， CR， ACA-IgG， anti-β2GPⅠ， CCL19， and sCD163 were significantly increased （P<0.01）. The serum levels of CCL19， sCD163， ESR， CR， ACA-IgG， and anti-β2GPⅠ were the risk factors for pregnancy failure of the SLE patients （P<0.05 or P<0.01）， while the levels of complement C3 and C4 were the protective factors （P<0.01）. The area under the ROC curve （AUC） of the serum CCL19 level for predicting the pregnancy failure of the SLE patients was 0.726， and the AUC of serum SCD163 level for predicting the pregnancy failure of the SLE patients was 0.789； the AUC of combination of both markers for predicting the pregnancy failure of the SLE patients was 0.835. The predictive performance of CCL19 and sCD163 for pregnancy outcomes of the SLE patients was superior to either marker alone （Z_{combined-CCL19}=3.066， P=0.002； Z_{combined-sCD163}=2.087， P=0.037）. Conclusion The serum levels of CCL19 and sCD163 in the SLE patients during pregnancy are significantly increased， which may cause the poor outcomes in the patients.

关键词

系统性红斑狼疮 / 妊娠期 / 趋化因子配体19 / 可溶性CD163 / 母婴结局

Key words

Systemic lupus erythematosus / Pregnancy / C-C chemokine ligand 19 / Soluble CD163 / Maternal and infant outcome

Author summay

刘 羽（1984-），男，山东省青岛市人，主治医师，医学硕士，主要从事妊娠并发风湿免疫性疾病方面的研究。