关键词: 红斑狼疮, 系统性；抗磷脂综合征；血管内皮生长因子；诊断；影响因素分析

Abstract: Background　The incidence of antiphospholipid syndrome（APS）is increasing year by year in China，and its coexistence with systemic lupus erythematosus（SLE）is closely related to poor prognosis.Serum vascular endothelial growth factor（VEGF）is a key regulator in the development of vasculitis，and plays an important role in the pathogenesis of SLE and APS.At present，there are few data on the association of serum VEGF with APS and SLE.Objective　The aim of this study was to assess the difference of serum VEGF levels in SLE patients with or without APS and to evaluate the clinical significance.Methods　A total of 84 female SLE patients were selected from Department of Rheumatology，the Second Affiliated Hospital of Hainan Medical University during May 2014 to May 2017，including 37 with APS（APS subgroup）and 47 without（non-APS subgroup）．33 age-matched healthy women（control group）were recruited from the Physical Examination Center of this hospital during the same period.General data，clinical characteristics，therapeutic drugs，disease activity，degree of SLE-induced damage and laboratory results were collected.Results　The serum VEGF level was significantly higher in the SLE patients〔（417.1±410.4）pg/ml vs（76.5±33.01）pg/ml〕than that of the controls（P<0.05）．APS subgroup showed greater age，longer course of SLE，larger dosage of prednisone，higher SLE disease activity index（SLEDAI），Systemic Lupus International Collaborating Clinics Damage index（SLICC DI），erythrocyte sedimentation rate（ESR），hemoglobin，white blood cell count，serum creatinine，rate of proteinuria，rate of positive anti-dsDNA antibodies，IgG anti-cardiolipin antibody（ACL），IgM ACL and VEGF，but demonstrated lower albumin compared with non-APS subgroup（P<0.05）．Serum VEGF level was not linearly correlated with age，duration of SLE，SLICC DI，ESR，hemoglobin，white blood cell count，serum creatinine，proteinuria，IgG and IgM ACL（P>0.05）．Serum VEGF level was positively correlated with prednisone dosage，SLEDAI，positive anti-dsDNA antibody，but negatively correlated with albumin（P<0.05）．Multivariate Logistic regression analysis showed that ESR，white blood cell count，proteinuria，positive anti-ds-DNA antibody，and serum VEGF were the influencing factors of APS in SLE（P<0.05）．The AUC of serum VEGF for the diagnosis of APS in SLE was 0.70〔95% CI（0.56，0.84）〕，with a cut-off value of 126.0 ng/L，72.0% sensitivity，and 60.0% specificity.Conclusion　Serum VEGF level was much higher in SLE patients with APS than that of those without，and it was found to be associated with APS in SLE，so it can be used for the diagnosis of APS in SLE to a certain degree.A SLE patient with elevated serum VEGF level suggests that he may have APS.

Key words: Lupus erythematosus, systemic；Antiphospholipid syndrome；Vascular endothelial growth factor；Diagnosis；Root cause analysis