钙卫蛋白作为类风湿性关节炎诊断标志物的研究  

Study of calprotectin as a diagnostic marker for rheumatoid arthritis

作　　者：陶李[1] 杜明[1] 王昱斌 李光迪[1] TAO Li;DU Ming;WANG Yi-Bin;LI Guang-Di(Department of Clinical Laboratory,Second Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第二医院检验中心

出　　处：《中国免疫学杂志》2019年第16期2011-2015,共5页Chinese Journal of Immunology

基　　金：兰州市科技计划项目(2014-1-35)

摘　　要：目的:检测类风湿性关节炎(RA)患者、骨关节炎(OA)患者以及健康对照(HCs)人群血清钙卫蛋白水平,评估血清钙卫蛋白对于类风湿性关节炎的诊断价值,并进一步探讨其与RA患者临床和实验室指标的关系。方法:采用酶联免疫吸附法(ELISA)检测RA组、OA组以及健康对照人群血清钙卫蛋白水平,收集3组人群的临床和实验室相关指标,用统计学方法分析钙卫蛋白对于RA的诊断价值以及其与RA患者临床疾病活动度及实验室相关参数之间的关系。结果:RA组血清钙卫蛋白水平(Median,77.7 ng/ml)显著高于OA组(Median,28.6 ng/ml)和健康对照组(Median,8.9 ng/ml),差异具有统计学意义(P<0.01)。运用ROC曲线,钙卫蛋白的cut-off值为46.08 ng/ml时,其对于诊断RA的敏感度为63.3%,特异度为90.4%,曲线下面积为0.82。在此cut-off值下,RA组中钙卫蛋白的阳性率(38/60,63.3%)要显著高于OA组(8/48,16.7%)和健康对照组(0/35,0%),差异具有统计学意义(P<0.01)。同时血清钙卫蛋白水平与RA患者28肿胀关节计数(SJC)、28疼痛关节计数(TJC)、DAS28评分、类风湿因子IgM(RF-IgM)、血沉(ESR)呈正相关,而与C反应蛋白(CRP)、抗环瓜氨酸肽抗体(anti-CCP)水平、疾病持续时间和年龄无相关性。在以DAS28为因变量的多元线性回归分析中,钙卫蛋白对于DAS28评分的影响大于CRP与ESR。结论:血清钙卫蛋白在RA中具有诊断作用和监测疾病活动性的能力,有希望成为RA的新血清标志物。Objective: To detect the level of serum calprotectin in patients with rheumatoid arthritis(RA),osteoarthritis(OA),and healthy controls(HCs).To evaluate the diagnostic value of serum calprotectin for rheumatoid arthritis and to further explore its relationship with clinical and laboratory indicators of RA patients. Methods: Serum calprotectin levels in RA group,OA group and healthy control group were detected by enzyme-linked immunosorbent assay(ELISA).Clinical and laboratory related indexes of three groups were collected.The diagnostic value of calprotectin for RA and its relationship with clinical disease activity and laboratory-related parameters in RA patients were analyzed statistically. Results: Serum calprotectin levels(Median,77.7 ng/ml)were significantly higher in the RA group than in the OA group(Median,28.6 ng/ml)and the healthy control group(Median,8.9 ng/ml).The difference was statistically significant ( P <0.01).Using the ROC curve,when the cut-off value of calprotectin was 46.08 ng/ml,its sensitivity to diagnosis of RA was 63.3%,and the specificity was 90.4%.The area under the curve is 0.82.At this cut-off value,the positive rate of calprotectin in the RA group (38/60,63.3%) was significantly higher than that in the OA group (8/48,16.7%) and the healthy control group (0/35,0%).The difference was statistically significant ( P <0.01).At the same time,serum calprotectin levels were positively correlated with 28 swollen joint counts,28 tender joint counts,DAS28 scores,rheumatoid factor IgM(RF-IgM),and erythrocyte sedimentation rate (ESR) in patients with RA.There was no correlation between citrullinated peptide antibody (anti-CCP) levels,ESR,disease duration,and age with serum calprotectin.In multiple linear regression analysis with DAS28 which acts as a dependent variable,calprotectin had a greater effect on DAS28 score than CRP and ESR. Conclusion: Serum calprotectin has the ability to diagnose and monitor disease activity in RA,and it is hopeful to become a new serum marker of RA.

关 键 词：类风湿性关节炎 钙卫蛋白 DAS28 

分 类 号：R593.22[医药卫生—内科学]