多项目联合检测在类风湿性关节炎诊断及活动度鉴别中的价值研究  

Value of multi item combined detection in the diagnosis and activity differentiation of rheumatoid arthritis

作　　者：王玉 陈晓俊 何平 陈伟[1] WANG Yu;CHEN Xiao-jun;HE Ping;CHEN Wei(Clinical Laboratory,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua,Zhejiang 321000,China)

机构地区：[1]浙江大学医学院附属金华医院检验科,浙江金华321000 [2]金华市第二医院老年科,浙江金华321000

出　　处：《中国卫生检验杂志》2022年第8期955-959,共5页Chinese Journal of Health Laboratory Technology

基　　金：金华市中心医院中青年科研启动基金(JY2017-2-10)。

摘　　要：目的探讨淋巴细胞亚群、免疫球蛋白游离κ链、游离λ链、补体C3、C4以及其他常用检测指标在类风湿性关节炎(RA)诊断及其活动度判断中的价值。方法选取2020年3月-12月在金华市中心医院住院的215例RA患者作为患者组,根据DAS28评分将RA患者分为活动期组(127例)和稳定期组(88例),同时期149例健康体检者作为正常组,比较研究组和正常组、RA活动期组和稳定期组类风湿因子(RF)、抗环瓜氨酸多肽抗体(抗CCP)、红细胞沉降率(ESR)、C-反应蛋白(CRP)、淋巴细胞亚群以及免疫球蛋白游离κ、λ链、补体C3、补体C4等指标水平,并采用ROC曲线评估其对RA的诊断和判别RA活动期的价值。结果研究组215例,正常组149例,研究组Th细胞、Ts细胞、游离κ链、游离λ链、抗CCP、ESR、CRP、RF高于正常组,差异有统计学意义(P<0.05)。活动期组的年龄、Td细胞、C3、游离κ链、游离λ链、ESR、CRP等指标均高于稳定期组,差异有统计学意义(P<0.05)。当RF的临界值为16.5 U/ml时,AUC为0.993,敏感度为80.0%,特异度为94.6%,诊断RA效能较高。当ESR的临界值为32.5 mm/h时,AUC为0.917,敏感度为79.5%,特异度为93.2%,鉴别RA活动期效能较高。结论淋巴细胞亚群分型中Th细胞、Ts细胞、免疫球蛋白游离κ链、游离λ链以及抗CCP、ESR、CRP、RF等指标在RA患者中高表达,其中,RF对于诊断RA有更高的敏感度;RA活动期患者淋巴细胞亚群分型中的Td细胞、免疫球蛋白游离κ链、游离λ链、C3以及ESR、CRP偏高,其中,ESR对于判断RA的活动度有更高的敏感度。Objective To explore the value of lymphocyte subsets,immunoglobulin free κ chain,free λ chain,complement C3,C4 and other common detection indexes in the diagnosis and activity determination of rheumatoid arthritis( RA).Methods A total of 215 RA patients hospitalized in Jinhua Central Hospital from March to December 2020 were selected as the patient group. According to disease activity score in 28 joints( DAS28),RA patients were divided into active group( 127cases) and stable group( 88 cases). 149 healthy subjects at the same time were selected as the normal group. The levels of rheumatoid factor( RF),anti-cyclic citrulline polypeptide antibody( anti-CCP),erythrocyte sedimentation rate( ESR),C-reactive protein( CRP),lymphocyte subsets,immunoglobulin free κ,λ chain,complement C3,complement C4 and other indexes were compared between the study group and the normal group,the active RA group and the stable RA group. ROC curve was used to evaluate its value in diagnosing RA and distinguishing active RA. Results There were 215 cases in the study group and 149 cases in the normal group. Th cells,Ts cells,free κ chain,free λ chain,anti-CCP,ESR,CRP,RF in the study group were higher than that in the normal group,and the differences were statistically significant( P < 0. 05). Age,Td cells,C3,free kappa chain predominate,free lambda chains,ESR,CRP and other indicators in activity group were higher than that in plateau group,with the differences statistically significant( P < 0. 05). When the critical value of RF was 16. 5 U/ml,AUC was 0. 993,sensitivity was 80. 0%,and specificity was 94. 6%. When the critical value of ESR was 32. 5 mm/h,the AUC was 0. 917,sensitivity was 79. 5%,and specificity was 93. 2%. Conclusion The expression of Th cell,Ts cell,immunoglobulin free κ chain,free λ chain and anti-CCP,ESR,CRP and RF were high in RA patients. RF was more sensitive to the diagnosis of RA. The Td cells,immunoglobulin free κ chain,free λ chain,C3,ESR and CRP were higher in the lymphocyte subsets of patients in RA active

关 键 词：类风湿性关节炎 淋巴细胞亚群 免疫球蛋白轻链 病情活动度 

分 类 号：R593.22[医药卫生—内科学]