Hcy结合血常规在强直性脊柱炎首次就诊确诊中的作用  

Role of homocysteine combined with multiple parameters in the blood routine test in the first diagnosis of ankylosing spondylitis

作　　者：赵丽 马进[1] 罗俊茜 解朋[2] 刘俊生 孙宏勋[1] ZHAO Li;MA Jin;LUO Junqian(Department of Laboratory Medicine,the Third Hospital of Hebei Medical University,Hebei,Shijiazhuang 050051,China;不详)

机构地区：[1]河北医科大学第三医院检验科,石家庄市050051 [2]河北医科大学第三医院核医学科,石家庄市050051 [3]山西省晋中市第一人民医院检验科

出　　处：《河北医药》2023年第14期2133-2136,共4页Hebei Medical Journal

摘　　要：目的基于强直性脊柱炎(AS)发病机制,分析同型半胱氨酸(Hcy)在AS患者中的表达情况,联合HLA-B27和血常规多参数[白细胞计数(WBC)、绝对淋巴细胞计数(ALC)和血小板计数(PLT)多指标]寻找有助于AS首次就诊确诊的实验室指标。方法利用实验室His和Lis系统,收集首次就诊即确诊为AS的患者基本信息和Hcy、WBC、ALC、PLT和HLA-B27数据。采用单因素检验分析Hcy、WBC、ALC、PLT与AS发病之间的关系。对于筛选的有意义变量(P<0.1),采用二分类Logistic回归进一步分析影响AS发病的因素,再构建Nomogram图,评估个体发病具体风险,并绘制校正曲线。最后绘制各指标的Roc曲线,计算最佳临界值(Cut off值)、敏感度和特异性(P<0.05)。结果研究共纳入健康对照个体和AS患者各152例,两者之间年龄、性别比差异无统计学意义(P<0.05)。AS患者平均年龄(34±11)岁,男性120例(78.9%),其中HLA-B27+者122例(80.3%)。HLA-B27+患者Hcy为15.3(11.0~20.5)μmol/L高于HLA-B27-患者的12.6(8.8~14.4)μmol/L(P<0.01)。经多因素校正的Logistic分析发现男性是女性发病风险的2.6倍,Hcy、WBC、PLT仍然是AS发病风险因素,均被用于构建Nomogram图。校正曲线表明模型预测良好。ROC分析表明,对于AS的诊断来说,Hcy(AUC=0.66,Cut off值为15.0μmol/L)的敏感性是91.4%,特异性是45.4%,WBC(AUC=0.78,Cut off值为6.41×10^(9)/L)的敏感性是78.3%,特异性是69.1%,PLT(AUC=0.72,Cut off值为257×10^(9)/L)的敏感性是75.0%,特异性是61.2%。3个指标联合诊断AS的AUC为0.85,敏感性是65.8%,特异性高达92.8%。结论Hcy在HLA-B27+患者中水平明显高于HLA-B27-患者,对于AS的诊断具有较高的灵敏度,Hcy、WBC和PLT联合指标诊断AS的特异性高达92.8%。四项风险因素构建的Nomogram图具有良好的预测价值,可为AS患者首次就诊确诊提供重要线索。Objective To seek laboratory indicators favoring the first diagnosis of ankylosing spondylitis(AS)by measuring the levels of homocysteine(Hcy),human leukocyte antigen B27(HLA-B27)and multiple parameters in the routine blood test like the white blood cell count(WBC),absolute lymphocyte count(ALC)and platelet count(PLT)based on the pathogenesis of AS.Methods Baseline characteristics of AS patients and their laboratory testing data(Hcy,WBC,ALC,PLT and HLA-B27)were collected through the hospital information system(His)and laboratory information system(Lis).Independent-samples t-test was utilized to analyze the relationship between Hcy and blood routine indexes,and the incidence of AS.For the screened significant variables(P<0.1),binary logistic regression analysis was used for further identifying the factors affecting the incidence of AS.Then the Nomogram was constructed to assess the specific risk of AS,and the calibration curve was drawn.Receiver operating characteristic(ROC)curves were depicted to calculate the cut-off value,sensitivity and specificity of the indexes with significant differences.Results A total of 152 AS patients were included in this study,involving 120 males(78.9%).The mean age of included AS patients was(34±11)years.There were 122/152 cases(80.3%)with positive expressions of HLA-B27.The expression level of Hcy was significantly higher in AS patients with positive expressions of HLA-B27 than those of negatives(15.3[11.0-20.5]μmol/L vs 12.6[8.8-14.4]μmol/L,P<0.01).Hcy,WBC and PLT were risk factors for the occurrence of AS.Binary logistic analysis demonstrated that men were more susceptible to AS than women with 2.6 times greater risk.The four indexes were used to construct nomograms,and the calibration curve showed that the prediction ability of the model was good.ROC analysis showed that the sensitivity and specificity of Hcy in discriminating AS were 91.4%and 45.4%(AUC=0.66,cut-off value=15.0μmol/L),respectively.The sensitivity and specificity of WBC were 78.3%and 69.1%(AUC=0.78,cut-off val

关 键 词：同型半胱氨酸 强直性脊柱炎 血常规参数 HLA-B27 Nomogram图 

分 类 号：R593.23[医药卫生—内科学]