相关实验室指标在早期类风湿性关节炎中的应用

Application of Related Laboratory Indexes in Early Rheumatoid Arthritis

目的评价目前众多类风湿性关节炎(RA)相关实验室指标并筛选出最优化的早期RA相关指标.方法设置RA组158例、早期RA组121例、正常对照组100例;检测各组总类风湿因子(RF)等14个指标并做统计分析;去除无统计学差别指标,以ROC曲线评价剩余指标在早期RA中的诊断效能,以AUC>0.75为标准,初步筛选出具有诊断效能的指标;将筛出指标做双变量相关分析,明显相关者归为一类.结果 (1)14项指标中,除RF IgA、CRP外,其余指标在3组中均有明显统计学差异(P<0.05);(2)单一指标检测曲线下面积(AUC)超过0.75的指标6项:GPI(0.929)、抗MCV(0.923)、RF IgG(0.904)、抗CCP(0.901)、APF(0.891)和总RF(0.880);(3)经双变量相关分析,6个指标与是否为早期RA均存在明显正相关,归集为3类:GPI类、抗MCV类(含抗CCP和APF)、RF IgG类(含总RF).结论 14项指标中,仅GPI类、抗MCV类及RF IgG类6项指标对早期RA具有较高诊断效能,实际工作中每类仅需选择1项开展即可,临床和实验室应避免重复或开展低效能检测.

Objective To evaluate the current related laboratory indicators of rheumatoid arthritis（RA）and screening out the optimal early RA-related indicators.Methods We selected 158 cases as RA group,121 cases as early RA group,100 cases as normal control group.The total rheumatoid factor and other 14 indicators were measured and analyzed statistically in each group.No statistical differences indicators were observed,the ROC curve was used to evaluate the diagnostic efficacy of the remaining indicators in early RA,AUC0.75 as the standard,indicators with diagnostic efficacy were initially screened.The sieve out indicators were used for bivariate correlation analysis,significant correlates are classified as a same class.Results（1） Among the 14 indicators,except for RF IgA and CRP,the other indexes were significantly different in the three groups（P〈0.05）.There were 6 indexes which exceeding 0.75 of area under the single index curve（AUC） ：GPI（0.929）,anti-MCV（0.923）,RF IgG（0.904）,anti-CCP（0.901）,APF（0.891） and total RF（0.880）;（3） By bivariate correlation analysis,there was a significant positive correlation between the six indexes and whether they were early RA,and classified as 3 groups：GPI group,anti-MCV group（including anti-CCP and APF）,RF IgG group（including total RF）.Conclusion In the 14 indicators,only 6 indicators（GPI class,anti-MCV class and RF IgG class） have higher diagnostic efficacy for early RA,we only need to choose one to carry out in each category in practice,so as to avoid clinical and laboratory duplication or low-performance testing.