基于决策曲线分析抗RA33、IL-6及hs-CRP水平对类风湿关节炎治疗反应性的预测价值  

Predictive value of anti-RA33,IL-6 and hs-CRP levels for treatment response in rheumatoid arthritis based on decision curve analysis

作　　者：耿学丽[1] 赵春楠 张泽智 刘艳伶 丁佩剑[3] GENG Xueli;ZHAO Chunnan;ZHANG Zezhi;LIU Yanling;DING Peijian(Department of Clinical Laboratory,Affiliated Hospital of Chengde Medical College,Chengde,Hebei 067000,China;Department of Rheumatology and Immunology,Affiliated Hospital of Chengde Medical College,Chengde,Hebei 067000,China;Department of Gastrointestinal Surgery,Affiliated Hospital of Chengde Medical College,Chengde,Hebei 067000,China)

机构地区：[1]承德医学院附属医院检验科,河北承德067000 [2]承德医学院附属医院风湿免疫科,河北承德067000 [3]承德医学院附属医院胃肠外科,河北承德067000

出　　处：《国际检验医学杂志》2024年第12期1431-1434,1441,共5页International Journal of Laboratory Medicine

基　　金：河北省医学科学研究课题计划(20200359)。

摘　　要：目的基于决策曲线分析抗类风湿关节炎-33(抗RA33)、白细胞介素-6(IL-6)及超敏C反应蛋白(hs-CRP)水平对类风湿关节炎(RA)患者治疗反应性的预测价值。方法选取2021年1月至2023年8月该院收治的102例RA患者,收集患者临床资料并检测其血清抗RA33、IL-6及hs-CRP水平。使用甲氨蝶呤与依那西普治疗半年后,根据治疗反应性分为反应良好组与无反应组。采用Pearson相关分析RA患者抗RA33、IL-6、hs-CRP水平与RA疾病活动评分(DAS28)的相关性,多因素Logistic回归分析RA患者治疗无反应的影响因素。绘制受试者工作特征(ROC)曲线,分析抗RA33、IL-6、hs-CRP在RA无反应中的效能。采用决策曲线分析抗RA33、IL-6、hs-CRP单独与联合预测RA患者治疗无反应的净收益情况。结果治疗半年后,反应良好和中度的患者共80例(反应良好组),无效22例(无反应组)。反应良好组病程短于无反应组,DAS28评分低于无反应组(P<0.05)。反应良好组血清抗RA33、IL-6、hs-CRP水平低于无反应组(P<0.05)。Pearson相关分析显示,血清抗RA33、IL-6、hs-CRP水平与DAS28评分均呈负相关(P<0.05)。多因素Logistic回归分析结果显示,DAS28评分及抗RA33、IL-6、hs-CRP水平为RA患者治疗无反应的影响因素(P<0.05)。ROC曲线显示,血清抗RA33、IL-6、hs-CRP单独及联合预测患者治疗无反应的曲线下面积分别为0.729、0.814、0.831、0.948,三者联合的预测价值更高。决策曲线分析显示,在大多合理阈值范围内,血清抗RA33、IL-6、hs-CRP联合预测对RA患者治疗反应性的总体净收益高于单独预测的净收益。结论抗RA33、IL-6、hs-CRP水平与RA患者治疗反应性密切相关,三者联合预测治疗无反应的临床价值及净收益较高。Objective To analyze the predictive value of anti-rheumatoid arthritis-33(anti-RA33),interleukin-6(IL-6)and high-sensitivity C-reactive protein(hs-CRP)levels for treatment response in patients with rheumatoid arthritis(RA)based on the decision curve.Methods A total of 102 RA patients admitted to the hospital from January 2021 to August 2023 were selected.The clinical data of the patients were collected and their serum anti-RA33,IL-6 and hs-CRP levels were detected.After half a year of treatment with methotrexate and etanercept,the patients were divided into good response group and non-response group according to the treatment response.Pearson correlation analysis was used to analyze the correlation between the levels of anti-RA33,IL-6,hs-CRP and disease activity score 28(DAS28)in RA patients.Multivariate Logistic regression analysis was used to analyze the influencing factors of non-response in RA patients.Receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of anti-RA33,IL-6 and hs-CRP in non-response to RA.The decision curve was used to analyze the net benefit of anti-RA33,IL-6 and hs-CRP alone or in combination to predict the non-response of RA patients to treatment.Results After half a year of treatment,80 patients had good or moderate response(good response group)and 22 patients had no response(non-response group).The course of disease in the good response group was shorter than that in the non-response group,and DAS28 score was lower than that in the non-response group(P<0.05).The levels of serum anti-RA33,IL-6 and hs-CRP in the good response group were lower than those in the non-response group(P<0.05).Pearson correlation analysis showed that the levels of serum anti-RA33,IL-6 and hs-CRP were negatively correlated with DAS28 score(P<0.05).Multivariate Logistic regression analysis showed that DAS28 score,anti-RA33,IL-6 and hs-CRP levels were the influencing factors of non-response to treatment in RA patients(P<0.05).ROC curves showed that the area under the curve of serum anti RA33,

关 键 词：类风湿关节炎 抗类风湿关节炎-33 白细胞介素-6 超敏C反应蛋白 决策曲线 治疗反应性 

分 类 号：R593.2[医药卫生—内科学]