血浆可溶性白细胞分化抗原14对类风湿关节炎患者合并细菌感染的临床诊断价值

Clinical diagnostic value of presepsin in patients with rheumatoid arthritis complicated with bacterial infection

目的探讨血浆可溶性白细胞分化抗原14（P—SEP）对RA患者合并肺部细菌感染的临床诊断价值。方法纳入133例RA患者及60名健康对照者为研究对象，RA合并肺部细菌感染组58例，RA无感染组75例，其中RA活动期43例和RA稳定期32例。应用化学发光酶免疫测试法检测所有研究对象外周血P—SEP，分析其与白细胞、ESR、CRP等炎性指标的相关性。组间比较采用方差分析，连续变量的相关性分析使用Pearson或Spearman相关分析，绘制受试者工作特征曲线，分析P—SEP鉴别诊断RA患者合并细菌感染的敏感性和特异性。结果RA合并肺部细菌感染组P—SEP水平（561±142）pg／ml高于RA活动期组（378±100）pg/ml（t=8．12，P〈0．01），高于RA稳定期组P—SEP（197±68）pg／ml（t=8．51，P〈0．01）和健康对照组P—SEP（113±9）pg／ml（t=13．75，P〈0．01）。RA合并肺部细菌感染组P—SEP与白细胞计数呈正相关（r=-0．627，P〈0.01）。同时测量RA无感染组患者，疾病活动度与CRP呈正相关（r=0．63，P〈0．01），与P—SEP水平无相关性（r=0．47，P=0．521）。P．SEP诊断RA患者合并细菌感染的最佳临界值为458．9pg／ml，敏感性为79．3％，特异性为81．4％。结论P—SEP对鉴别RA患者是否合并细菌感染有重要的诊断价值，与RA疾病活动度无关。

Objective To investigate the clinical diagnostic value of plasma soluble leukocyte differentiation antigen 14 （presepsin） in patients with rheumatoid arthritis （RA） complicated with pulmonary bacterial infection. Methods A total of 133 patients with RA and 60 healthy controls were enrolled in this study. Fifty-eight RA patients were infected with lung bacterial infection and 75 Patients were non-infected with RA. Among them, RA activity was performed in 43 patients and RA was stable in 32 patients. Chemilluminescence immnnoassay was used to detect presepsin （P-SEP） in all subjects, and its correlation with inflammatory markers such as white blood cells, blood sedimentation rate and C-reactive protein was analyzed. Results The P-SEP of RA （561 ±142） pg/ml combined with pulmonary bacterial infection group was significantly higher than that of active RA group （378±100） pg/ml （t=8.12, P〈0.01）, higher than that of stable RA group （197±68） pg/ml （t=8.51, P〈0.01） and healthy control group （113±9） pg/ml （t=13.75, P〈0.01）. There was a positive correlation between P-SEP and leukocyte count in patients with RA complicated with pulmonary bacterial infection （r=0.627, P〈0.01）. The degree of the disease activity was correlated with CRP （r=0.63, P〈0.01）, regardless of the P-SEP level （r=0.47, P=0.521）. The optimal threshold value of P-SEP in diagnosing RA patients with bacterial infection was 458.9 pg/ml, with a sensitivity of 79.3% and a specificity of 81.4%. Conclusion P-SEP has an important diagnostic value for the identification of bacterial infection in RA patients, which is not related to RA disease activity.