血清淀粉样蛋白A水平在幼年特发性关节炎疾病活动度评估中的价值分析

Clinical value of serum amyloid A in assessment of disease activity for juvenile idiopathic arthritis

目的研究血清淀粉样蛋白A(serum amyloid A protein,SAA)在幼年特发性关节炎(juvenile idiopathic arthritis,JIA)疾病活动度评估中的临床应用价值。方法选取JIA患儿102例收集其血常规、SAA、血沉(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)及骨密度结果,采用幼年关节炎疾病活动评分(juvenile arthritis disease activity score with 27 joints,JADAS-27)对疾病活动程度进行评估并比较其相关性。采用便利抽样法选取年龄性别成组匹配的健康体检儿童51例作为对照组。结果 JIA患儿血清SAA水平显著高于健康对照组(96.1 mg/L vs 16.8 mg/L,P<0.05)。血清SAA水平在全身型JIA患儿中较关节型患儿升高明显。活动期JIA患儿SAA水平较稳定期显著升高。SAA与CRP(r=0.819)、ESR(r=0.712)均呈显著正相关(P<0.01)。SAA的ROC曲线下面积(area under the ROC curve,AUC)达0.795,仅次于血沉(AUC=0.860),较CRP及其他指标更高。当SAA或血小板任意一项异常,且二者之和大于354时,判断疾病活动敏感性达0.71,特异性达0.84。JADAS-27评分与SAA、CRP均呈低度相关(r值0.33-0.48,P<0.01),与血沉呈中度相关(r=0.64)。疾病高度活动状态下,SAA显著升高。结论 SAA,尤其是SAA联合血小板计数增高,有望作为新的JIA疾病活动度评估指标,值得在临床进一步推广。

Objective To investigate the clinical value of serum amyloid A （SAA） in the assessment of the disease activity of juvenile idiopathic arthritis （JIA）. Methods A total of 102 JIA children admitted in our department from February 2016 to February 2017 were enrolled in this study. Their results of blood routine test, SAA level, erythrocyte sedimentation rate （ESR）, bone mineral density, and C-reactive protein （CRP） level were collected. The disease activity was evaluated by the juvenile arthritis disease activity score with 27-joints reduced count （JADAS-27）. Another 51 age- and sex-matched healthy children taking physical examination in our hospital in the same period were selected as control group. Results The SAA level was significantly higher in the JIA children than the control （96.1 vs 16.8 mg/L, P 〈0.05 ）. Compared with the joint type of JIA, SAA levels were obviously elevated in the systemic JIA. And the level was notably higher in the children with active JIA than those in the stable state. SAA level was positively correlated with CRP level （r =0.819, P 〈0.01 ） and ESR （r =0.712, P 〈0.01 ）. The area under the receiver operative characteristiccurve （AUC） of SAA was O. 799, wmcn was lower than than of CRP and other indexes. When SAA or platelet was abnormal, and the sum of the 2 values was greater than 354, the sensitivity of disease activity was 0.71, and the specificity was 0.84. JADAS-27 score was mildly correlated with SAA level and CRP level （ r = 0.33 - 0.48, P 〈 0.01 ） , and was moderately correlated with ESR （r = 0. 64 ）. SAA level was significantly higher in the JIA children with high disease activity. Gonclusion SAA, especially combined with increased platelet count, is expected to become a new assessment indicator for JIA disease activity, and worth of further promotion in clinical practice.