CAJ | 학술논문

目的：探讨血清C反应蛋白(CRP)水平测定在系统性红斑狼疮(SLE)合并感染的患者诊治中的意义。方法选择2010年9月~2014年8月广东佛山市顺德第一人民医院风湿免疫科收治的196例SLE患者为研究对象，分别测定所有患者血清CRP水平和红细胞沉降率(ESR)，并按照SLE疾病活动指数评分标准(SLEDAI)进行疾病活动度评价，比较SLE合并和不合并感染患者血清CRP水平、ESR、SLEDAI，并比较不合并感染的SLE患者治疗前后上述指标。比较不合并感染的SLE患者不同疾病活动度时CRP、ESR；绘制CRP诊断SLE患者合并感染的ROC曲线，分析血清CRP测定对SLE患者合并感染的诊断价值。比较是否合并浆膜积液、肾脏损害、血液系统损害、神经系统损害、皮肤黏膜损害的SLE患者的血清CRP水平。结果 SLE合并感染患者血清CRP水平和ESR均高于不合并感染患者(均P<0.05)，而SLEDAI在合并和不合并感染的SLE患者之间差异无统计学意义(P>0.05)；不合并感染的SLE患者随着疾病活动度的增加血清CRP水平变化不大(P>0.05)，而ESR呈增高趋势(P<0.05)；合并感染的SLE患者免疫抑制剂治疗后CRP、ESR、SLEDAI均较治疗前显著降低，差异有统计学意义(均P<0.05)；以CRP>8.1 mg/L作为诊断截断点，CRP诊断SLE患者合并感染的敏感性和特异性分别为69.8%和83.6%；是否合并浆膜积液、肾脏损害、血液系统损害、神经系统损害、皮肤黏膜损害的SLE患者血清CRP水平差异均无统计学意义(P>0.05)。结论 SLE患者血清CRP水平与疾病活动和器官受累无相关性，血清CRP水平升高可作为SLE患者合并感染的诊断指标，为临床抗感染治疗提供依据。
목적：탐토혈청C반응단백(CRP)수평측정재계통성홍반랑창(SLE)합병감염적환자진치중적의의。방법선택2010년9월~2014년8월엄동불산시순덕제일인민의원풍습면역과수치적196례SLE환자위연구대상，분별측정소유환자혈청CRP수평화홍세포침강솔(ESR)，병안조SLE질병활동지수평분표준(SLEDAI)진행질병활동도평개，비교SLE합병화불합병감염환자혈청CRP수평、ESR、SLEDAI，병비교불합병감염적SLE환자치료전후상술지표。비교불합병감염적SLE환자불동질병활동도시CRP、ESR；회제CRP진단SLE환자합병감염적ROC곡선，분석혈청CRP측정대SLE환자합병감염적진단개치。비교시부합병장막적액、신장손해、혈액계통손해、신경계통손해、피부점막손해적SLE환자적혈청CRP수평。결과 SLE합병감염환자혈청CRP수평화ESR균고우불합병감염환자(균P<0.05)，이SLEDAI재합병화불합병감염적SLE환자지간차이무통계학의의(P>0.05)；불합병감염적SLE환자수착질병활동도적증가혈청CRP수평변화불대(P>0.05)，이ESR정증고추세(P<0.05)；합병감염적SLE환자면역억제제치료후CRP、ESR、SLEDAI균교치료전현저강저，차이유통계학의의(균P<0.05)；이CRP>8.1 mg/L작위진단절단점，CRP진단SLE환자합병감염적민감성화특이성분별위69.8%화83.6%；시부합병장막적액、신장손해、혈액계통손해、신경계통손해、피부점막손해적SLE환자혈청CRP수평차이균무통계학의의(P>0.05)。결론 SLE환자혈청CRP수평여질병활동화기관수루무상관성，혈청CRP수평승고가작위SLE환자합병감염적진단지표，위림상항감염치료제공의거。
Objective To investigate the clinical significance of C reactive protein (CRP) levels in the diagnosis of the patients with systemic lupus erythematosus (SLE) co-infection. Methods 196 patients with SLE admitted to rheumatism immunity branch of the First People's Hospital of Shunde from September 2010 to August 2014 were as the research objects, the level of serum CRP and erythrocyte sedimentation rate (ESR) of all the patients were determined respec-tively, and the SLE disease activity according to systemic lupus erythematosus disease activity index (SLEDAI) were e-valuated, serum level of CRP, ESR, SLEDAI in SLE patients with co-infection or without were compared, and the in-dexes mentioned above in SLE patients with co-infection were compared. CRP, ESR in SLE patients in different infec-tion degrees were compared; ROC curve of CRP in diagnosis of SLE patients was drew, the diagnostic value of serum CRP in SLE patients with co-infection was analyzed, serum CRP levels in SLE patients with or without kidney damage, blood system damage, nervous system damage, damage of skin mucous membrane were compared. Results Serum levels of CRP and ESR of SLE patients with co-infection on admission were higher than those of the patients without infection (all P< 0.05), while there was no statistically significant differences in SLEDAI between the patients with co-infection or not (P>0.05);serum CRP level had little change with the disease activity increasing of SLE patients with infection (P> 0.05), while ESR increased (P< 0.05); CRP, ESR and SLEDAI of SLE patients with co-infection after immune inhibitor decreased significantly, the difference was statistically significant (all P< 0.05); the sensitivity and specificity of CRP in diagnosis of SLE patients were 69.8% and 83.6% according to CRP > 8.1 mg/L, the differences of serum CRP levels in SLE patients with merge serous effusion, kidney damage, blood system damage, nervous system damage, damage of skin mucous membrane or not were not statistical significance (P>0.05). Conclusion The level of serum CRP of SLE patients has not correlation with the disease activity and organ involvement, elevated serum CRP levels can be used as a diagnostic index in SLE patients and provide evidences for clinical anti infection treatment.