ASSESSMENT OF DISEASE-ACTIVITY AND IMPENDING FLARE IN PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS - COMPARISON OF THE USE OF COMPLEMENT SPLIT PRODUCTS AND CONVENTIONAL MEASUREMENTS OF COMPLEMENT
ASSESSMENT OF DISEASE-ACTIVITY AND IMPENDING FLARE IN PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS - COMPARISON OF THE USE OF COMPLEMENT SPLIT PRODUCTS AND CONVENTIONAL MEASUREMENTS OF COMPLEMENT
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DOI：
10.1002/art.1780350907
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发表时间：
1992-09-01
影响因子：
--
通讯作者：
ABRAMSON, SB
中科院分区：
文献类型：
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作者：
BUYON, JP;TAMERIUS, J;ABRAMSON, SB
目标。在系统性红斑狼疮（SLE）患者中，确定替代途径或经典途径激活中产生的补体分裂产物水平的增加是否伴随着更严重的疾病活动，以及这些测量是否有助于预测疾病的爆发。研究人员对86例SLE患者的380份血浆样本进行了Ba、Bb、SC5b-9和C4d水平的检测，并对这些患者进行了15个月的前瞻性随访。在研究开始时患有非活动性疾病的20例患者中，所有补体分裂产物在进入时的平均值都在正常范围内。在47例稳定或中度疾病活动性患者中，Ba水平显著升高，而Bb、SC5b-9和C4d的平均值与非活动性患者无显著差异。每种分析物的平均进入值在初始评估时疾病活动性最严重的19例患者组中最高。补体的传统测量，即C3， C4和CH50，遵循类似的趋势，但在三组患者之间以及分裂产物的测量中没有区别。对不活跃或稳定/中度疾病患者的病程分析显示，C4d水平升高对随后的Hare最敏感，而Bb水平升高特异性最高，预测价值最大。这些数据表明，补体分裂产物水平的升高，特别是替代途径和终末途径激活的产物，比常规的补体测量更准确地反映SLE的疾病活动性，并可能有助于预测即将发生的疾病发作。
Objective. To determine whether increased levels of the complement split products generated in the activation of the alternative or classical pathway accompany more severe disease activity in patients with systemic lupus erythematosus (SLE) and whether these measurements are useful in predicting flares of disease.Methods. Levels of Ba, Bb, SC5b-9, and C4d were measured in 380 plasma samples obtained from 86 SLE patients who were prospectively followed up for 15 months.Results. In the 20 patients who had inactive disease at the initiation of the study, the mean values of all of the complement split products at entry were within the normal range. In the 47 patients with stable or moderate disease activity, levels of Ba were significantly increased, while the mean values for Bb, SC5b-9, and C4d did not differ significantly from those in patients with inactive disease. The mean entry value of each analyte was highest in the group of 19 patients who had the most severe disease activity at initial evaluation. Traditional measurements of complement, i.e., C3, C4, and CH50, followed similar trends, but did not discriminate between the 3 groups of patients as well as did measurements of the split products. Analysis of the disease course in the patients with inactive or stable/moderate disease revealed that an elevated level of C4d had the most sensitivity with regard to subsequent Hare, while an elevated Bb level had the highest specificity and the greatest predictive value.Conclusion. These data suggest that elevated levels of complement split products, particularly products of alternative and terminal pathway activation, more accurately reflect disease activity than do conventional measurements of complement in SLE and may be useful in the prediction of impending disease flares.