轻链λ对RF和抗CCP抗体阴性的类风湿关节炎的临床价值研究

Diagnostic value of serum light chain lambda in sero-negative rheumatoid arthritis patients

为了评价类风湿因子(RF)和抗CCP抗体阴性的关节炎患者就诊时血清轻链λ水平对类风湿关节炎(RA)的诊断价值,回顾性分析我院住院RA患者的临床资料,获取患者初诊的RF、抗环瓜氨酸肽(CCP)抗体、免疫球蛋白(Ig)和轻链等数据。根据RF和抗CCP抗体水平,RA患者分为自身抗体阴性组和阳性组。将血清阴性RA患者作为实验组,与非RA关节炎患者构成的对照组进行比较,用受试者工作特征曲线(ROC)和多元Logistic回归分析轻链λ对RA患者诊断的临床价值。结果显示,实验组较对照组关节炎患者的轻链λ水平升高,差异具有统计学意义(P=0.026);ROC分析表明轻链λ对关节炎患者发展为RA具有预测价值,曲线下面积(AUC)达到0.665[95%CI(0.518,0.812)];以620.5mg/dl为临界值,预测RA的敏感性为0.565(0.345,0.768),特异性为0.804(0.661,0.906);多元Logistic回归校正后轻链λ仍然与关节炎患者发生RA相关(OR=3.551,P=0.037)。研究结果表明,血清轻链λ水平对关节炎患者发展为RA具有一定的预测价值。

To investigate the diagnostic value of serum lambda light chain in patients with sero-negative rheumatoid arthritis,the clinical data of 217 RA patients attended to the Affiliated Hospital of Nantong University between Feb.2013 and Feb.2014 were retrospectively reviewed.The laboratory parameters,including rheumatoid factor（RF）,anti-cyclic citrullinate peptide（anti-CCP）antibody,lambda and kappa light chains and immunoglobulin G,A and M were collected from the Laboratory Information System（LIS）.The RA patients were divided into sero-negative and sero-positive groups according to the serum levels of RF and anti-CCP.The data of sero-negative RA patients and other arthritis patients were accessed by the receiver operating curve（ROC）analysis and multivariable logistical model.The results showed that the median（interquartile range）of serum lambda level was 637（471,784）mg/dl and 497.5（420,596.75）mg/dl respectively in RA patients and the other arthritis patients（Z=2.221,P=0.026）.ROC analysis showed that lambda chain was an efficient parameter for the diagnosis of seronegative RA patients,with the area under curve（AUC）being 0.665（95%CI：34.5~76.8）.The optimal cut-off value of lambda chain was 620.5mg/dl,with the sensitivity being 0.565（0.345-0.768）and specificity being 0.804（0.661~0.906）.Logistic regression analysis showed that serum lambda chain was still associated with RA diagnosis after adjustment（OR=3.551,P=0.037）.So serum lambda chain could be used as an auxiliary factor for the diagnosis of sero-negative RA.