| Objective:To explore the value of red blood cell distribution width(RDW)and other related inflammatory markers in the diagnosis and disease activity of SLE,by measuring these indicators in patients with Systemic lupus erythematosus(SLE),Methods:In this study,healthy people and patients who were enrolled from July2017 to September 2020 were selected as the research objects.A total of 918 patients were included in the SLE group as the case group,933 patients were included in the RA group as the case control group,and 954 patients were included in the healthy control group.With informed consent,venous blood was collected on an empty stomach in the early morning of the next day to determine the blood biochemical indicators(CRP,complement C3,complement C4,immunoglobulin Ig A,immunoglobulin Ig G,immunoglobulin Ig E,immunoglobulin Ig M,ESR and other immune-related indicators),and compare the differences of laboratory indicators between the three groups.At the same time according to different clinical features in patients with SLE disease activity,and whether the MS,and whether the combining nephritis)layering of subgroup analysis,analysis of RDW and other indicators in SLE and the difference between the groups with different SLEDAI correlation,laboratory evaluation index can be as indicators of disease surveillance,using ROC curve analysis of various indicators of performance to the diagnosis of SLE.Results:1.General information of the subjects:the healthy control group consisted of954 patients;there were 933 patients in RA control group,including 166 males and767 females,aged(48.45±12.05)years.There were 929 patients in SLE group,including 78 males and 851 females,aged(48.35±20.17)years.There were no statistically significant differences in age(F=4.095,P=0.393)and marital status(x~2=1.114,P=0.573)among the three groups.There were statistically significant differences in gender(x~2=14.989,P=0.005)and educational level(x~2=616.983,P<0.001)among the three groups.2.Comparison of laboratory related indicators such as RDW among the three groups:the content of RDW in the healthy control group was 12.80(12.40,13.20),the content of RA group was 13.60(12.90,14.70),and the content of SLE group was14.50(13.04,17.00).The difference of RDW content among the three groups was statistically significant(H=357.365,P<0.001).There was significant difference in RDW content between male and female(H=134.672,P<0.001;H=273.657,P<0.001).The RDW content of the female healthy control group was 12.70(12.40,13.20),which was statistically significant different from that of the RA group(13.60,12.90,14.70)(P<0.05),and that of the SLE group was 14.55(13.08,16.96)(P<0.05).The RDW content of the male healthy control group was 12.80(12.50,13.20),which had no statistical significance compared with that of the RA group(13.70,13.00,14.83)(P>0.05),and that of the SLE group was 14.34(12.80,17.12)(P<0.05).There was no significant difference between male immunoglobulin LGA and complement C groups(H=2.508,P=0.285;H=3.343,P=0.188).Other laboratory indicators(NLR,CRP,RF,complement C3,complement C4,Ig A,Ig G,Ig M,Ig E,ESR)in males and all laboratory indicators in females were significantly different among the three groups(P<0.05).3.Correlation analysis of RDW and other laboratory indicators with disease activity(SLEDAI-2000)in patients with SLE:RDW was moderately correlated with SLEDAI(r_s=0.474,P<0.001),CRP,RF,complement C3,complement C4,Ig G and ESR were also correlated with SLEDAI(P<0.05).Correlation coefficients were 0.353,0.471,-0.505,-0.329,0.451,0.567,respectively.Other laboratory indicators(NLR,Ig M,and Ig E)had no correlation with SLEDAI.4.Comparison of RDW and other laboratory-related indicators between SLE-MS group and SLE-n MS group:SLE-n MS patients were divided into SLE-n MS group(n=654)and SLE-MS group(n=275)according to whether SLE-MS patients complicated with metabolic syndrome(MS).Among 929 SLE patients,275 were MS patients,accounting for 29.60%.RDW level was 14.50(13.00,16.81)in the SLE-NMS group and 14.60(13.165,17.525)in the SLE-MS group,respectively,and the difference between groups was not statistically significant(Z=-1.437,P=0.151).There were statistically significant differences among NLR,CRP,Ig A,Ig E and ESR groups(P<0.05).RDW was correlated with SLEDAI in SLE-n MS group and SLE-MS group(r_s=0.435,P<0.001;r_s=0.564,P<0.001).No difference was found in the distribution of RDW in SLE patients with or without MS,but it was correlated with disease activity.5.Comparison of RDW and other laboratory-related indicators among SLE-n LN group,SLE-n RLN group and SLE-RLN group:according to whether SLE patients complicated with nephritis and refractory,they were divided into SLE-n LN group(n=532),SLE-n RL group(n=325)and SLE-RLN group(n=72).Among 929 patients with SLE,397 patients with LN,accounting for 42.73%,and 72 patients with refractory nephritis,are accounting for 7.75%.The levels of RDW in SLE-n LN group,SLE-n RLN group and SLE-RLN group were 14.60(13.06,17.03),14.47(13.10,16.92)and 14.50(12.75,17.23),respectively,and the difference was not statistically significant(H=0.057,P=0.812).There were statistically significant differences in NLR,CRP,Ig A,Ig M and Ig E among the three groups(H=9.609,P=0.002;H=6.086,P=0.014;H=5.301,P=0.021;H=22.948,P<0.001 and H=6.364,P=0.012).There was no significant difference in the distribution of RDW in SLE patients with or without LN,but it was correlated with disease activity(except in SLE patients with RLN).6.Comparison of RDW and other laboratory-related indicators among SLE activity groups:according to the disease activity of SLE patients,SLE patients were divided into SLE-no activity group(n=155),SLE-mild activity group(n=363),SLE-moderate activity group(n=298)and SLE-severe activity group(n=113).The levels of RDW in SLE-inactive group,SLE-mild activity group,SLE-moderate activity group and SLE-severe activity group were 13.90(13.00,15.27),13.21(10.97,15.27),15.39(13.78,17.13)and 21.74(19.90,24.68),the difference was statistically significant(H=305.813,P<0.001).The correlation coefficient between RDW and SLEDAI was r_s=0.191,P=0.017;r_s=0.073,P=0.165;r_s=0.304,P<0.001 and r_s=0.709,P<0.001,respectively,in SLE-inactive group,SLE-mild activity group,SLE-moderate activity group and SLE-severe activity group The distribution of RDW was different among SLE patients with different activity levels.In SLE patients with severe activity,RDW had a high correlation with disease activity,while in SLE patients with mild activity,RDW had not find correlation or a low correlation with disease activity.7.ROC curve analysis of RDW and other laboratory-related indicators in diagnosing SLE:(1)The ROC curve analysis results of single laboratory indicators show that:The Area under the curve(AUC)of RDW was 0.647,the cut-off value was13.81,the sensitivity was 0.608,the specificity was 0.751,and the Youden index was0.359.(2)The ROC curve analysis results of multi-indicator joint laboratory indicators showed that the highest AUC,sensitivity,specificity and Youden index of the three indicators(RDW,NLR and CRP)in the joint diagnosis of SLE were 0.786,0.739,0.724 and 0.463,respectively.Conclusion:1.The level of RDW in SLE patients was significantly higher than that in the healthy control group,and the distribution of RDW in SLE patients with different activity levels was different,but it was not related to whether patients complicated with metabolic syndrome or nephritis.2.RDW was correlated with disease activity,and there was a high correlation between RDW and disease activity in SLE patients with moderate to severe activity.3.RDW has a high diagnostic value for SLE,and combined with other indicators can improve the diagnostic value for SLE.Therefore,RDW will have certain clinical application value as an auxiliary index for the diagnosis of SLE and the evaluation of disease activity in patients. 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