الفهرس 
Systemic Lupus ErythematosusOnly 14 pages are availabe for public view
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Abstract
The aim of this study was to assess the variations of urinary plasmin levels in SLE patients and to study its relation to disease manifestations, activity status and disease severity.
This study was carried out on:
group (I): Fifty SLE, diagnosed according to SLICC criteria. The patients were divided into: group Ia: Twenty eight SLE patients with LN. group Ib: Twenty two SLE patients without LN.
group II: Twenty apparently healthy subjects were carefully chosen, matched for age and sex with the SLE patients.
All patients provided an informed written consent prior to participation in this study. Also approvals for having a renal biopsy from active LN cases were provided.
These patients were selected randomly from the in-patients’ and the out-patients’ clinics of the Rheumatology, Rehabilitation and Physical Medicine Department of Benha University Hospitals.
Patients with the following conditions were excluded from the study:
-Age <16 years,
-Suffered from other autoimmune disease, congenital renal disease or any risk factors for renal insult.
- Renal replacement therapy.
-Pregnant females.
-Active infection (urinary tract or systemic infection) which was confirmed to be free of infection by negative urine bacterial culture and by the absence of any features suggestive of infection upon follow up in the absence of antibiotic treatment.
All patients were subjected to full history taking, complete clinical examination and laboratory investigations.
Urine samples (5ml) were collected from all subjects by sterile tube then measurement of urinary plasmin antibodies using enzyme-linked immunosorbent assay (ELISA kits, Shanghai, China) according to the manufacturer’s instructions.
Renal Biopsy was obtained ultrasound guided using a true cut needle biopsy, from SLE patients with active LN based on parameters of renal SLEDAI score then analyzed and graded using the International Society of Nephrology/Renal Pathology Society classification.
Venous blood samples from all participants were collected and the following laboratory parameters were ordered; complete blood count (CBC) using a Sysmex 5000 counter; erythrocyte sedimentation rate (ESR) determination using the Wintergreen method and C-reactive protein (CRP) by latex agglutination slide test, kidney function tests (serum creatinine, blood urea, creatinine clearance), Complement (C3&C4) by immunodiffusion plate method, Antinuclear antibodies (ANA) by indirect immunofluorescent test using HEP-2 substrate, (IMMCO Diagnostics, Inc., USA), anti-double stranded deoxyribonucleic acid (anti-dSDNA) antibodies by EIA (the Binding Site, Birmingham, U.K), complete urine analysis, 24 hs urinary protein and protein to creatinine ratio (P/ C ratio).
As a preparatory step for renal biopsy, the prothrombin time (PT), Partial thromboplastin time (PPT) and international Normalized Ratio (INR) were determined on Diagnostica Stago (Asnieres, France).
Statistical analysis:
The collected data were analyzed by the computer program SPSS (Statistical package for social science) version 26. Quantitative data were expressed as means, standard deviation, Frequency and distribution. Student’s t- test, ANOVA test (F value), chi square test (X2-value) and fisher exact test (FET) were used to examine the significance of differences according to type of data. The correlation between quantitative variables were done using spearman’s correlation analyses and receiver operating characteristics (ROC) analysis was used to detect validity of urinary plasmin in prediction of cases. P- value less than 0.05 was considered as significant and less than 0.001 highly significant.
Results of the present study showed that:
1-No statistical differences between the studied groups regarding age and sex distribution.
2-There was highly statistically significant difference (P<0.001) between SLE cases and control group as regard mean urinary plasmin level.
3-There was statistically significant difference (p=0.03) as regard mean urinary plasmin level among SLE cases being higher in SLE with LN than SLE without LN.
4-High significant differences were found (p˂0.001) between (SLE patients with & without LN) and control group as regard HB level, RBCs count, C3 levels, C4 levels, ESR and CRP levels being higher in SLE cases. Insignificant differences were found as regard WBCs, PL count and S. creatinine (P>0.05)
5-As regard 24h urinary proteins; there was a high significant difference (p˂0.001) between SLE patients with LN compared to SLE without LN and control group being higher in SLE patients with LN.
6-Highly significant difference as regard P/C ratio being higher in SLE cases with LN when compared to SLE cases without LN and between SLE without LN and healthy control group.
7-Mean urinary plasmin level was statistically significantly highly elevated in SLE cases with renal manifestations (p<0.001), while there were no significant increase in urinary plasmin associated with other clinical manifestations (p>0.05).
8-Renal biopsy was obtained from active LN (n=18) patients and according to ISN/RPS, there were 6 cases with grade II, 4 cases with grade III, 5 cases with grade IV and 3 case with grade V with mean±SD activity index score of 6.15±4.94 and mean±SD chronicity index score of 3.4±0.12.
9-Significant difference (P=0.02) was observed between active and inactive LN patients regarding mean urinary plasmin level.
10-Significant positive correlations were reported between mean urinary plasmin level and disease duration (r=0.326 P=0.01), ESR (r=0.560 P=
> 0.001 ), CRP (r=0.804 P= > 0.001), 24H urinary proteins (r=0.237 P=0.004), S.creat (r=0.041 P=0.02), blood urea (r=0.728 P= > 0.001), SLEDAI score (r=0.631 P= > 0.001), rSLEDAI score (r=0.341 P=
0.015) and SLICC damage index (r=0.339 P= 0.016).
11-Diagnostic performance of urinary plasmin in the current study, Area under the curve 0.591 (0.461-0.721) with 95%, Confidence Interval at cutoff point 40.31, its sensitivity was 84%, its specificity was 65%, its positive predictive value was 85.71, its negative predictive value was
61.9 and its total accuracy was 87.7%.