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

摘要： 背景　抗磷脂综合征（APS）在我国发病率逐年增加，伴APS的系统性红斑狼疮（SLE）患者的预后较差。血清血管内皮生长因子（VEGF）是血管炎性因子生成的关键调节剂，在SLE和APS的发病过程中起重要作用。目前关于血清VEGF与APS和SLE关系的研究较少。目的　检测并分析伴或不伴APS的SLE患者血清VEGF水平差异及临床意义。方法　选取2014年5月—2017年5月于海南医学院第二附属医院风湿病科就诊的女性SLE患者84例，其中伴APS 37例（APS组），不伴APS 47例（无APS组）。同期选取于本院体检中心体检的年龄与SLE患者匹配的女性健康受试者33例作为对照组。收集患者一般资料、临床特征、治疗药物、疾病活动度、疾病损害程度、实验室检查结果。结果　SLE患者血清VEGF水平为（417.1±410.4）ng/L，高于对照组血清VEGF水平〔（76.5±33.0）ng/L〕（P<0.05）。APS组年龄、病程、泼尼松剂量、系统性红斑狼疮疾病活动指数（SLEDAI）、系统性红斑狼疮国际合作诊所损伤指数（SLICC DI）、红细胞沉降率（ESR）、血红蛋白、白细胞计数、血肌酐、蛋白尿、抗ds-DNA抗体阳性率、IgG型抗心磷脂抗体（ACL）、IgM型ACL、血清VEGF水平均高于无APS组，清蛋白低于无APS组（P<0.05）。血清VEGF水平与年龄、病程、SLICC DI、ESR、血红蛋白、白细胞计数、血肌酐、蛋白尿、IgG型ACL、IgM型ACL无直线相关关系（P>0.05）；血清VEGF水平与泼尼松剂量、SLEDAI、抗ds-DNA抗体阳性呈正相关，与清蛋白呈负相关（P<0.05）。多因素Logistic回归分析结果显示，ESR、白细胞计数、蛋白尿、抗ds-DNA抗体阳性、血清VEGF是SLE患者伴APS的影响因素（P<0.05）。血清VEGF诊断SLE患者伴APS的受试者工作特征曲线下面积为0.70，95%CI（0.56，0.84），截断值为126.0 ng/L，灵敏度为72.0%，特异度为60.0%。结论　伴有APS的SLE患者血清VEGF水平较无APS的SLE患者高，且血清VEGF是SLE患者伴APS的影响因素，血清VEGF对SLE患者伴APS具有一定诊断价值，提示SLE患者血清VEGF水平升高可能提示伴有APS。

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