血清CXCL13在类风湿关节炎中的表达及意义

Expression and significance of serum CXCL13 in rheumatoid arthritis

目的探讨类风湿关节炎(rheumatoid arthritis,RA)患者血清CXCL13表达及其临床意义。方法 RA患者81例为RA组,同期体检健康者21例为对照组,采用ELISA法检测2组血清CXCL13水平,比较以红细胞沉降率计算的28个关节疾病活动指数(disease activity score 28erythrocyte sedimentation rate,DAS28ESR)、临床疾病活动性指数(clinical disease activity index,CDAI)、简化的疾病活动性指数(simplified disease activity index,SDAI)。根据DAS28ESR将RA患者分为高、中、低度活动度者分别为21、26、34例,比较其血清CXCL13水平,DAS28ESR、SDAI及CDAI;Pearson相关法分析血清CXCL13与DAS28ESR、SDAI、CDAI的相关性;ROC曲线分析血清CXCL13诊断RA的效能。结果 RA组血清CXCL13水平[(97.17±54.43)ng/L]明显高于对照组[(42.91±10.71)ng/L](P<0.05);RA疾病高度活动度者血清CXCL13水平[(148.99±58.70)ng/L]高于中度及低度活动度者[(88.69±45.91)、(72.06±35.02)ng/L](P<0.05),中度活动度者血清CXCL13水平与低度活动度者比较差异无统计学意义(P>0.05);RA高度活动度者DAS28ESR(6.25±0.86)、SDAI(36.55±14.24)、CDAI(32.97±11.94)均高于中度活动度者(4.08±0.60、15.34±6.14、13.73±4.87)及低度活动度者(2.17±0.61、3.58±2.99、3.12±2.79)(P<0.05),且中度活动度者高于低度活动度者(P<0.05);Pearson相关分析结果显示,RA组血清CXCL13水平与DAS28ESR、SDAI、CDAI均呈正相关(r=0.508,P<0.001;r=0.430,P<0.001;r=0.422,P<0.001);ROC曲线分析结果显示,血清CXCL13以55.67ng/L为最佳截断值,诊断RA的AUC为0.86(95%CI:0.78~0.94,P<0.001),准确率为71.95%,灵敏度为72.84%,特异度为99.11%。结论 RA患者血清CXCL13水平明显升高,且增高幅度与疾病活动度相关;血清CXCL13可作为评估RA患者病情严重程度的参考指标,在RA诊断中有较高价值。

Objective To explore the expression and significance of serum CXCL13 in rheumatoid arthritis （RA）. Methods Serum CXCL13 was detected by ELISA method in 81 patients with RA （RA group） and 21 healthy volunteers （control group）. Disease activity score 28 erythrocyte sedimentation rate （DAS28ESR）, simplified disease activity index （SDAI） and clinical disease activity index （CDAI） were calculated. The patients with RA were divided into high, medium and low disease activity score （DAS） groups （n= 21, 26, 34） according to DAS28ESR to compare the changes of CXCL13, DAS28ESR, SDAI and CDAI. The correlations of serum CXCL13 with DAS28ESR, SDAI and CDAI were analyzed by Pearson correlation analysis, and the efficacy of serum CXCL13 on the diagnosis of RA was evaluated by ROC curve. Results The CXCL13 level was significantly higher in RA group （（97. 17±4.43） ng/L） than that in control group （（42.91±10.71） ng/L） （P〈0.05）. The CXCL13 level was significantly higher in high DAS group （（148.99±58.70） ng/L） than that in medium DAS group （（88.69±5.91） ng/L） and low DAS group （（72.06±35.02） ng/L） （P〈0.05）, and there was no significant difference between medium DAS group and low DAS group （P〉0.05）. The DAS28ESR score （6.25 ±0. 86）, SDAI （36. 55± 14. 24） and CDAI （32. 97± 11. 94） were significantly higher in high DAS group than those in medium DAS group （4.08±0. 60, 15.34±6. 14, 13.73±4.87） and low DAS group （2. 17± 0.61, 3.58±2.99, 3. 12±2. 79） （P〈0.05）, and in medium DAS group than those in low DAS group （P〈0.05）.Pearson correlation analysis showed that serum CXCL13 level was positively correlated with DAS28ESR, SDAI and CDAI inRAgroup （r=0.508, P〈0.001; r=0.430, P〈0.001; r=0.422, P〈0.001）. ROC curve analysis showed that the optimal cut-off value of serum CXCL13 was 55.67 ng/L, the AUC for diagnosing RA was 0.86 （95% CI： 0. 78 0. 94, P〈0.001）, with the accuracy of 71. 95%, the sensitivity of 72. 84% and specificity of 99. 11% respectively. Conclusion The serum CXCL13 level is significantly higher in RA patients and is correlated with DAS, with a high value to the diagnosis of RA as a reference for assessing the severity of RA.