血清胰岛素样生长因子结合蛋白4与类风湿性关节炎疾病活动度的相关性及预测模型构建  

Correlation between Serum IGFBP4 and Disease Activity in Patients with Rheumatoid Arthritis and Construction of A Prediction Model

作　　者：朱泽琴 梁扬扬 姜春蕾 薛菁[3] 池淑红[2] ZHU Zeqin;LIANG Yangyang;JIANG Chunlei;XUE Jing;CHI Shuhong(Ningxia Medical University,Yinchuan 750004,China;Department of Rheumatology and Immunology,General Hospital of Ningxia Medical University,The First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China;Laboratory of Pathogenic Microbiology of General Hospital of Ningxia Medical University,The First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学,银川750004 [2]宁夏医科大学总医院风湿免疫科,宁夏医科大学第一临床医学院,银川750004 [3]宁夏医科大学总医院病原微生物实验室,宁夏医科大学第一临床医学院,银川750004

出　　处：《宁夏医科大学学报》2025年第1期41-46,共6页Journal of Ningxia Medical University

基　　金：宁夏回族自治区重点研发计划项目(2023BEG03014)。

摘　　要：目的 探讨类风湿性关节炎(RA)患者血清中胰岛素样生长因子结合蛋白4(IGFBP4)的表达与28个关节疾病活动评分(DAS28-ESR)的相关性并构建活动度风险预测列线图。方法 采用酶联免疫吸附实验(ELISA)检测112例RA患者与56例健康体检者血清中IGFBP4的表达。56例体检者作为健康组(n=56),112例RA患者按DAS28-ESR评分分为稳定组(n=56)和活动组(n=56)。利用Spearman相关系数与Logistic回归分析血清中IGFBP4水平与RA疾病活动度之间的相关风险因素,并构建风险预测列线图模型。用校准曲线、决策曲线(DCA)以及受试者工作特征曲线下面积(AUC)验证这些模型的准确性和临床效用。结果 RA组血清IGFBP4水平高于健康组(P<0.001),RA稳定组与健康组比较血清IGFBP4水平升高,且活动组高于稳定组(P均<0.05)。Spearman相关性分析显示,IGFBP4与RA疾病活动指标[如红细胞沉降率(ESR)、C-反应蛋白(CRP)、临床疾病活动指数(CDAI)及简化疾病活动指数(SDAI)等]呈正相关(P均<0.05);单/多因素分析筛选出关节压痛计数、IGFBP4、ESR、抗环瓜氨酸肽抗体(ACPA)及CRP可作为RA活动度发生的独立危险因素(P均<0.05)。列线图可有效识别RA发生活动度的风险,列线图ROC曲线面积为0.943,校准曲线及决策曲线分别具有较高的拟合度及临床净收益。结论 基于IGFBP4联合临床经典指标(ACPA、ESR、CRP及关节压痛计数)可建立有效识别RA活动度的列线图。Objective To explore the correlation between the expression of insulin-like growth factor binding protein 4(IGFBP4)in the serum of patients with rheumatoid arthritis(RA)and disease activity score(DAS)28-erythrocyte sedimentation rate(ESR)(DAS28-ESR),and constructing a nomogram for predicting activity risk.Methods The expression of IGFBP4 in the serum of 112 RA patients and 56 healthy subjects was detected using enzyme-linked immunosorbent assay(ELISA).Fifty-six individuals from routine physical exams were recruited as the healthy control group(n=56),while 112 RA patients were categorized into a stable group(n=56)and an active group(n=56)using the DAS28-ESR score.Spearman correlation coefficient and binary logistic regression were utilized to analyze the risk factors associated with serum IGFBP4 levels and disease activity in RA.A risk prediction nomogram model was then constructed.Calibration curves,decision curves analysis(DCA),and area under subject characteristic curves(AUC)were used to validate the accuracy and clinical utility of these models.Results The IGFBP4 level in the serum of RA group was markedly higher than that in the healthy group(P<0.001).The serum IGFBP4 level was increased in the RA stable group when compared with the healthy group,and it was even higher in the active group than in the stable group(P<0.05 in both instances).Spearman correlation analysis revealed a significant association between IGFBP4 levels and disease activity indicators of RA,such as erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),clinical disease activity index(CDAI),simplified disease activity index(SDAI),etc.Single/multi-factor analysis identified the number of joint tenderness,IGFBP4,ESR,anti-citrullinated protein antibodies(ACPA),and CRP as independent risk factors for the occurrence of RA disease activity(P all<0.05).The nomogram effectively identified the risk of active RA.The ROC curve area of the nomogram was 0.943,indicating high accuracy.Additionally,both calibration curve fit and decision curve analy

关 键 词：类风湿性关节炎 胰岛素样生长因子结合蛋白4 疾病活动度 列线图 

分 类 号：R593.22[医药卫生—内科学]