D-二聚体/纤维蛋白原比值、白蛋白/纤维蛋白原比值与全身型幼年特发性关节炎合并巨噬细胞活化综合征的相关性分析  

Correlation Analysis Between D-dimer/fibrinogen Ratio,Albumin/fibrinogen Ratio and Systemic Juvenile Idiopathic Arthritis with Macrophage Activation Syndrome

作　　者：刘平[1] 江春亚 王向丽[1] 靳云凤[1] 魏磊[1] 陈莹华 李迪[1] 刘翠华[1] LIU Ping;JIANG Chun-ya;WANG Xiang-li;JIN Yun-feng;WEI Lei;CHEN Ying-hua;LI Di;LIU Cui-hua

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院,河南郑州450000

出　　处：《风湿病与关节炎》2024年第6期21-25,共5页Rheumatism and Arthritis

基　　金：河南省医学科技攻关项目(LHGJ20210623)。

摘　　要：目的:探讨D-二聚体/纤维蛋白原比值(DFR)、白蛋白/纤维蛋白原比值(AFR)与全身型幼年特发性关节炎(sJIA)合并巨噬细胞活化综合征(MAS)的相关性。方法:选取2017年1月至2022年6月在河南省儿童医院确诊的初治sJIA患者68例为sJIA组,sJIA合并MAS患者32例为MAS组,收集患儿确诊sJIA和MAS时24 h内临床表现及实验室指标并进行比较。DFR、AFR与实验室指标的相关性采用Spearman相关分析,通过绘制受试者工作特征曲线(ROC)评价DFR、AFR在sJIA合并MAS诊断中的价值。结果:①MAS组纤维蛋白原和血白蛋白明显低于sJIA组,而D-二聚体、DFR、AFR明显高于sJIA组,差异有统计学意义(P < 0.01)。②DFR、AFR与天冬氨酸转氨酶、谷丙转氨酶、乳酸脱氢酶、甘油三酯、血清铁蛋白呈正相关,与C反应蛋白、红细胞沉降率、白细胞计数、血小板计数呈负相关,差异有统计学意义(P < 0.05)。③多重线性回归分析显示,AFR与sJIA合并MAS诊断呈独立相关(P < 0.05)。④根据ROC曲线,DFR、AFR用于诊断sJIA合并MAS的最佳截断值分别为0.86和11.16(敏感性92.6%,特异性为85.7%,AUC=0.956;敏感性为97.1%,特异性为78.6%,AUC=0.946)。而两者联合诊断敏感性为94.1%,特异性为92.9%,AUC=0.98。结论:DFR、AFR与sJIA合并MAS病情活动相关,两者联合检测有助于MAS的早期诊断。Objective:To explore the correlation between D-dimer/fibrinogen ratio(DFR),albumin/fibrinogen ratio(AFR)and systemic juvenile idiopathic arthritis(sJIA)with macrophage activation syndrome(MAS).Methods:Sixty-eight newly diagnosed sJIA patients at Henan Children's Hospital from January 2017 to June 2022 were selected as the sJIA group,and 32 sJIA patients combined with MAS were selected as the MAS group.Collect clinical manifestations and laboratory indicators within 24 hours of diagnosis of sJIA and MAS in pediatric patients and compare them.The correlation between DFR,AFR and laboratory indicators was analyzed using Spearman correlation analysis.The value of DFR and AFR in the diagnosis of sJIA combined with MAS was evaluated by drawing receiver operating characteristic curves(ROCs).Results:①The levels of fibrinogen and serum albumin in the MAS group were significantly lower than those in the sJIA group,while D-dimer,DFR,and AFR were significantly higher than those in the sJIA group,with statistical significance(P<0.01).②DFR and AFR were positively correlated with aspartate aminotransferase,alanine aminotransferase,lactate dehydrogenase,triglycerides,and serum ferritin,while negatively correlated with C-reactive protein,erythrocyte sedimentation rate,white blood cell count,and platelet count,with statistically significant differences(P<0.05).③Multiple linear regression analysis showed an independent correlation(P<0.05)between the diagnosis of AFR and sJIA combined with MAS.④According to the ROC curve,the optimal cutoff values for DFR and AFR in diagnosing sJIA combined with MAS were 0.86 and 11.16,respectively(sensitivity 92.6%,specificity 85.7%,AUC=0.956;sensitivity 97.1%,specificity 78.6%,AUC=0.946).The combined diagnostic sensitivity of DFR and AFR was 94.1%(specificity 92.9%,AUC=0.98).Conclusion:DFR and AFR are related to the activity of sJIA combined with MAS,and their combined detection is helpful for the early diagnosis of MAS.

关 键 词：全身型幼年特发性关节炎 巨噬细胞活化综合征 D-二聚体/纤维蛋白原比值 白蛋白/纤维蛋白原比值 

分 类 号：R725.9[医药卫生—儿科]