血清抵抗素水平在幼年特发性关节炎诊断中的意义  

Significance of serum resistin level in the diagnosis of juvenile idiopathic arthritis

作　　者：朱光耀[1] 郝胜[2] 夏敏[3] 何威逊[2] 郭桂梅 Zhu Guangyao;Hao Sheng;Xia Min;He Weixun;Guo Guimei(Department of Critical Care Medicine,Shanghai Children′s Hospital,Shanghai Jiaotong University,Shanghai 200062,China;Department of Nephrology and Rheumatology,Children′s Hospital of Shanghai Jiaotong University,Children′s Hospital of Shanghai,Shanghai 200062,China;Department of Laboratory,Children′s Hospital of Shanghai Jiaotong University,Children′s Hospital of Shanghai,Shanghai 200062,China;Department of Pediatric Nephrology,Xinhua Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院重症医学科,200062 [2]上海市儿童医院,上海交通大学附属儿童医院肾脏风湿科,200062 [3]上海市儿童医院,上海交通大学附属儿童医院检验科,200062 [4]上海交通大学医学院附属新华医院小儿肾脏内科,200092

出　　处：《中华实用儿科临床杂志》2020年第14期1085-1088,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨血清抵抗素对幼年特发性关节炎(JIA)患儿的意义。方法前瞻性观察2013年10月至2015年9月上海市儿童医院肾脏风湿科住院及门诊确诊为全身型JIA(SOJIA)患儿32例(SOJIA组),非全身型JIA(N-SOJIA)患儿52例(N-SOJIA组),其他风湿性疾病患儿33例(其他风湿病组),儿童保健门诊健康体检儿童30例(健康对照组)。采用夹心酶联免疫吸附试验法(ELISA)检测其血清抵抗素水平,并结合临床资料及相关实验室检查指标进行综合分析。收集各组性别、年龄、体质量指数(BMI)等基本资料,收集JIA组患儿疾病持续时间、类风湿因子、抗核抗体、白细胞、血红蛋白、血小板、C反应蛋白(CRP)、红细胞沉降率(ESR)、临床表现及目前使用药物情况等指标。采用受试者工作特征曲线(ROC)分析抵抗素水平诊断SOJIA的敏感度及特异度。结果SOJIA组、N-SOJIA组、其他风湿病组和健康对照组患儿年龄、性别及BMI比较差异均无统计学意义。SOJIA组和N-SOJIA组患儿临床表现均有关节炎,其中发热、皮疹在SOJIA组中较多,差异有统计学意义(P<0.01),实验室结果显示白细胞、CRP、ESR在SOJIA组明显升高,抗核抗体主要在N-SOJIA组中阳性率较高(P<0.05)。SOJIA组患儿血清抵抗素水平[(17.98±13.78)mg/L]高于N-SOJIA组[(9.86±6.11)mg/L]、其他风湿病组[(8.00±6.28)mg/L]和健康对照组[(1.84±1.66)mg/L],差异有统计学意义(F=21.625,P<0.01)。抵抗素与白细胞、CRP均呈正相关(r=0.532、0.351,均P<0.05),与BMI、血红蛋白、血小板、ESR无相关性(r=0.059、-0.176、0.152、0.203,均P>0.05)。根据ROC曲线预测SOJIA诊断的截断值为5.55 mg/L,曲线下面积是0.802,对应的敏感度为96.9%,特异度为49.6%。结论JIA患儿血清抵抗素水平升高,尤其在SOJIA患儿中升高显著;血清抵抗素水平可作为临床诊断SOJIA的新的血清学指标,≥5.55 mg/L是较为适宜的诊断界限值。Objective To investigate the clinical significance of serum resistin in juvenile idiopathic arthritis(JIA)patients.Methods A prospective observational study was performed and 32 cases of patients with systemic onset JIA(SOJIA)(SOJIA group)in children admitted to the nephrorheumatology and outpatient were enrolled at Children′s Hospital of Shanghai between October 2013 and September 2015,52 cases of other types(N-SOJIA group),and 33 cases of other rheumatic diseases(other rheumatic diseases group),30 cases of children undergoing health checkups in the child health outpatient clinic(healthy control group)were involved as well.Serum resistin levels were measured by enzyme-linked immunosorbent assay(ELISA),and comprehensive analysis was carried out with clinical data and related laboratory findings.The basic data of gender,age and body mass index(BMI)of each group were collected,and the duration of disease in children in JIA group,rheumatoid factor,antinuclear antibody,white blood cell,hemoglobin,platelet,C reacting protein(CRP),erythrocyte sedimentation rate(ESR),clinical manifestations and current drug use were collected.Using the receiver operating characteristic(ROC)curve analysis of sensitivity and specificity resistin levels in diagnostic systemic juvenile idiopathic arthritis.Results There was no statistically significant difference in the age,gender and BMI of children in SOJIA group,N-SOJIA group,other rheumatism group and healthy control group.Children in the SOJIA group and the N-SOJIA group had arthritis in clinical manifestations.Fever and rash were more common in the SOJIA group,and the difference was statistically significant(P<0.01).Laboratory results showed that the sedimentation rates of white blood cells,CRP,and red blood cells were in the SOJIA group was significantly elevated.The antinuclear antibody was mainly found in the N-SOJIA group with a higher positive rate(P<0.05).The mean serum resistin in the SOJIA group[(17.98±13.78)mg/L]was higher compared to the healthy control group[(1.84±1.66)

关 键 词：抵抗素 幼年特发性关节炎 受试者工作特征曲线 诊断 

分 类 号：R725.9[医药卫生—儿科]