SLEDAI-2000与BILAG-2004两种评分系统评估狼疮性肾炎患儿肾脏活动度的可行性研究

Feasibility of SLEDAI-2000 and BILAG-2004 scoring systems for assessing renal disease activity in children with lupus nephritis

摘要:

目的：分析系统性红斑狼疮疾病活动指数2000（SLEDAI-2000）和英国狼疮评估组2004（BILAG-2004）两种评分系统在评估狼疮性肾炎（LN）患儿肾脏病变活动度方面的可行性。方法：收集159例系统性红斑狼疮（SLE）合并LN患儿的临床资料，应用 BILAG-2004和 SLEDAI-2000两种临床评分系统判断其临床疾病活动度。进行两种评分与24 h尿蛋白定量、病理指数的相关分析。用ROC曲线对两种评分系统进行评价。结果：24 h尿蛋白定量分级以中量蛋白尿居多（31.5%），病理类型以弥漫性LN(Ⅳ型)最多，占46.0％；24 h尿蛋白定量与两种评分均呈正相关（r值分别为0.36和0.39，均P＜0.05）；LN患者Ⅰ～Ⅳ型的活动指数（AI）值与SLEDAI-2000评分均呈正相关(r值分别为0.86、0.88、0.84和0.77，均P＜0.05)，与BILAG-2004评分亦均呈正相关（r值分别为0.88、0.98、0.86和0.89，均P＜0.05）；SLEDAI-2000评分与Ⅱ型LN患者AI评分相关性最好，其次为Ⅰ型；BILAG-2004评分与Ⅱ型LN患者AI评分相关性最好，其次为Ⅳ型；BILAG-2004评分系统的曲线下面积（AUC）为0.93，SLEDAI-2000 AUC为0.88。结论：BILAG-2004和SLEDAI-2000评分系统均可以评估LN患者的肾脏病变活动度。BILAG-2004评分系统结果更加可靠，更加全面。

Abstract:

OBJECTIVE: To study feasibility of Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2000) and British Isles Lupus Assessment Group 2004 (BILAG-2004) scoring systems for assessing renal disease activity in children with lupus nephritis (LN). METHODS: The clinical data of 159 children with systemic lupus erythematosus (SLE) and LN were collected, and disease activity was assessed by SLEDAI-2000 and BILAG-2004 scoring systems. The correlations between SLEDAI-2000 and BILAG-2004 scores and 24-hour urinary protein excretion and renal pathology index were analyzed. The SLEDAI-2000 and BILAG-2004 scoring systems were evaluated using ROC curve. RESULTS: Approximately one third (31.5%) of the 159 children had a moderate level of 24-hour urinary protein excretion. Among the 37 patients undergoing renal biopsy, 46.0% had diffuse LN (type Ⅳ). 24-hour urinary protein excretion was positively correlated with both SLEDAI-2000 (r=0.36, P<0.05) and BILAG-2004 scores (r= 0.39, P<0.05). Children with types Ⅰ, Ⅱ, Ⅲ, and Ⅳ LN had pathology activity index (AI) which positively correlated with SLEDAI-2000 scores (r=0.86, 0.88, 0.84, 0.77 respectively; P<0.05) and BILAG-2004 scores (r= 0.88, 0.98, 0.86, 0.89 respectively; P<0.05). SLEDAI-2000 score showed the best correlation with AI in patients with type Ⅱ LN, followed by those with type Ⅰ LN. BIILAG-2004 score showed the best correlation with AI in patients with type Ⅱ LN, followed by those with type Ⅳ LN. The BILAG-2004 scoring system had an area under the ROC curve (AUC) of 0.93, and the SLEDAI-2000 scoring system had an AUC of 0.88. CONCLUSIONS: BILAG-2004 and SLEDAI-2000 scoring systems can be used to assess renal disease activity of patients with LN. The BILAG-2004 scoring system can provide more reliable and comprehensive assessment.