CD64指数、白介素、肿瘤坏死因子-α与类风湿关节炎病情活动和继发感染的关系

Correlation of rheumatoid arthritis disease activity, secondary infection with the CD64 index,interleukins,TNF-α of patients

目的探讨CD64指数、白介素(IL)和肿瘤坏死因子(TNF)-α与类风湿关节炎(RA)病情活动及继发感染的关系,并进一步分析其临床意义,为临床治疗RA提供参考依据。方法选取2015年9月至2017年10月就诊于长海医院的63例RA患者作为研究对象,按临床表现和实验室检查结果分为稳定期组21例、活动期组24例和细菌感染组18例,比较三组患者外周血CD64指数、IL-6、IL-8、IL-10、IL-1β、IL-2受体和TNF-α水平,分析CD64指数、IL和TNF-α与RA患者病情活动及感染指标的相关性。结果细菌感染组CD64指数、IL-6、IL-8、IL-10、TNF-α以及IL-2受体水平均高于活动期组和稳定期组,且上述指标活动期组均高于稳定期组,差异有统计学意义(P<0.05或P<0.01)。细菌感染组C反应蛋白(CRP)、血沉(ESR)、降钙素原(PCT)和铁蛋白水平均高于稳定期组和活动期,且上述指标活动期组均高于稳定期组,差异有统计学意义(P<0.01)。相关性分析结果显示,细菌感染组CD64指数与白细胞计数(WBC)、PCT、铁蛋白呈正相关(r=0.800,r=0.617,r=0.567,P<0.05或P<0.01),IL-6与CRP呈正相关(r=0.800,P<0.01),IL-1β与ESR呈正相关(r=0.582,P<0.05)。而活动期组CD64指数与WBC呈正相关(r=0.769,P<0.01),IL-10与CRP呈负相关(r=-0.678,P<0.01),IL-1β与铁蛋白呈正相关(r=0.566,P<0.01),IL-2受体与ESR呈正相关(r=0.511,P<0.05)。结论 CD64指数、IL、TNF-α与RA患者病情活动及继发感染密切相关,可以作为RA活动期和感染期的鉴别指标。

Objective To investigate the correlation of rheumatoid arthritis（RA） disease activity, secondary infection with CD64 index, interleukins, and tumor necrosis factor（TNF）-α in patients to provide reference for the clinical treatment of RA. Methods A total of 63 cases of patients with RA, who were treated in Changhai hospital from September 2015 to October 2017, were selected and divided into stable stage group（n=21）, active stage group（n=24） and bacterial infection group（n=18） according to clinical manifestation and laboratory results. The peripheral blood CD64 index, interleukins（IL-6, IL-8, IL-10, IL-1β, IL-2 receptor） and TNF-α levels were compared among the three groups. The correlation between CD64 index, interleukins, TNF-α and the disease activity, infection index of RA patients were analyzed. Results The levels of CD64 index, IL-6, IL-8, IL-10, IL-2 receptor and TNF-α in the bacterial infection group were significantly higher than those in both active stage group and stable stage group, and those indexes in the active stage group were all higher than those in stable stage group（P〈0.05 or P〈0.01）. The levels of CRP, ESR, PCT and ferritin in bacterial infection group were significantly higher than those in active stage group and stable stage group, and the above indexes in the active stage group were all higher than those in the stable stage group（P〈0.01）. After correlation analysis, in the bacterial infection group, the CD64 index was positively correlated with WBC, PCT and ferritin（r=0.800, r=0.617, r=0.567, P〈0.05 or P〈0.01）, the IL-6 was positively correlated with CRP（r=0.800, P〈0.01）, and the IL-1β was positively correlated with ESR（r=0.582, P〈0.05）. However, in active stage group, the CD64 index was positively correlated with WBC（r=0.769, P〈0.01）, the IL-10 was negatively correlated with CRP（r=-0.678, P〈0.01）, and the IL-1β was positively correlated with ferritin（r=0.566, P〈0.01）. The IL-2 receptor was positively correlated with ESR（r=0.511, P〈0.05）. Conclusion The CD64 index, interleukins and TNF-α are closely related to the disease activity and the infection of RA patients, which can be used as the identification indexes of RA disease activity and secondary infection.