25(OH)D、D-D和FDP对类风湿关节炎活动度的鉴别诊断价值  

The value of 25(OH)D,D-D and FDP in the differentiation of rheumatoid arthritis activity

作　　者：马继登 吕艳锞 李子安[1] 阿祥仁[1] 周健武 曹春花 周丹 程鹏[1] 杨博杰 MA Jideng;LYU Yanke;LI Zian;A Xiangren;ZHOU Jianwu;CAO Chunhua;ZHOU Dan;CHENG Peng;YANG Bojie(Department of Medical Laboratory,Qinghai Provincial People′s Hospital,Xining,Qinghai 810007,China;Qinghai University,Xining,Qinghai 810001,China)

机构地区：[1]青海省人民医院医学检验科,青海西宁810007 [2]青海大学,青海西宁810001

出　　处：《检验医学与临床》2024年第2期161-165,共5页Laboratory Medicine and Clinic

基　　金：青海省卫生健康系统重点课题(2021-wjzdx-25);青海省“昆仑英才•高端创新创业人才”计划[青人才字(2021)13号]。

摘　　要：目的探讨25羟基维生素D[25(OH)D]、D-二聚体(D-D)、纤维蛋白降解产物(FDP)对类风湿关节炎(RA)活动度的鉴别诊断价值。方法选取2022年9月至2023年2月在青海省人民医院就诊的101例活动期RA患者作为RA活动组(RAA组),79例缓解期RA患者作为RA缓解组(RAR组),90例其他自身免疫性疾病(OA)患者作为OA组,90例健康体检者作为HC组。检测所有研究对象空腹外周血25(OH)D、D-D、FDP、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)水平;采用Spearman相关评价D-D、FDP、抗环瓜氨酸肽抗体、ESR、RF、CRP、28关节活动度评分与25(OH)D的相关性;采用受试者工作特征(ROC)曲线评价各项指标单独及联合检测对RA活动度的鉴别诊断价值。结果RAA组与RAR组、OA组和HC组25(OH)D、D-D、FDP水平比较,差异均有统计学意义(P<0.05),RAR组与HC组25(OH)D水平比较,差异有统计学意义(P<0.05);OA组与HC组D-D和FDP水平比较,差异均有统计学意义(P<0.05)。25(OH)D与7项指标均呈负相关(P<0.05),但相关性均较弱。ROC曲线分析结果显示,当25(OH)D最佳截断值为16.41 U/mL时AUC为0.708,灵敏度为82.2%,特异度为60.8%;当D-D最佳截断值为1.90 U/mL时AUC为0.670,灵敏度为90.1%,特异度为46.8%;当FDP最佳截断值为6.10 U/mL时AUC为0.665,灵敏度为88.1%,特异度为44.3%;ESR、CRP、D-D、FDP与25(OH)D联合检测的AUC为0.959。结论血清25(OH)D、FDP和D-D对RA疾病活动度有一定的鉴别诊断价值。ESR、CRP、D-D、FDP与25(OH)D联合检测时鉴别诊断价值更高。Objective To investigate the diagnostic value of 25-hydroxyvitamin D[25(OH)D],D-dimer(D-D)and fibrin degradation products(FDP)in the differential diagnosis of rheumatoid arthritis(RA)activity.Methods A total of 101 patients with active RA in Qinghai Provincial People′s Hospital from September 2022 to February 2023 were selected as RA activity group(RAA group),79 patients with RA in remission were selected as RA remission group(RAR group),and 90 patients with other autoimmune diseases during the same period were selected as OA group,and 90 healthy subjects were selected as HC group.The levels of 25(OH)D,D-D,FDP,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and rheumatoid factor(RF)in fasting peripheral blood were detected.Spearman correlation was used to evaluate D-D,FDP,anti-cyclic citrullinated antibody,ESR,RF,CRP,DAS28 scores and 25(OH)D levels.The receiver operating characteristic(ROC)curve was used to evaluate the differential diagnostic value of each index alone and combined detection for RA activity.Results The levels of 25(OH)D,D-D and FDP in RAA group were significantly different from those in RAR group,OA group and HC group(P<0.05).The 25(OH)D level in RAR group was significantly different from that in HC group(P<0.05).There were significant differences in D-D and FDP levels between the OA group and the HC group(P<0.05),and the 25(OH)D was negatively correlated with the 7 indexes(P<0.05),but the correlation was weak.ROC curve analysis showed that when the best cut-off value of 25(OH)D was 16.41 U/mL,the AUC was 0.708,the sensitivity was 82.2%,and the specificity was 60.8%.When the optimal cut-off value of D-D was 1.90 U/mL,the AUC was 0.670,the sensitivity was 90.1%,and the specificity was 46.8%.When the optimal cut-off value of FDP was 6.10 U/mL,the AUC was 0.665,the sensitivity was 88.1%,and the specificity was 44.3%.The AUC of the combined detection of ESR,CRP,D-D,FDP and 25(OH)D was 0.959.Conclusion The serum levels of 25(OH)D,FDP and D-D have certain value in the differential diagnosi

关 键 词：类风湿关节炎 25羟基维生素D D-二聚体 纤维蛋白降解产物 疾病活动度 

分 类 号：R593.22[医药卫生—内科学]