血浆sCD14-ST在类风湿关节炎合并感染者中的表达及临床意义

The diagnostic value and prognostic significance of plasma presepsin in patients with rheumatoid arthritis(RA)patients combined with infection

目的探讨血浆可溶性白细胞分化抗原14亚型(sCD14-ST)对类风湿关节炎(RA)伴感染者的诊断价值及临床意义。方法采用前瞻性研究方法,选取2016年1-10月青岛大学附属医院收治的RA稳定期患者58例(RA稳定期组)、RA活动期患者43例(RA活动期组)及RA合并感染患者33例(RA合并感染组),同时选取44例体检健康者作为健康对照组,测定各组研究对象血浆sCD14-ST水平变化,分析其与C反应蛋白(CRP)、红细胞沉降率的相关性;绘制受试者工作特征曲线(ROC曲线)评估血浆sCD14-ST对RA合并感染患者预后的预测价值。结果 RA合并感染组、RA活动期组、RA稳定期组、健康对照组研究对象血浆sCD14-ST水平中位数(四分位间距)分别为1 428(972～3 606)、246(205～479)、172(121～352)、158(61～306)pg/mL。4组研究对象sCD14-ST水平比较,差异有统计学意义(H=56.17,P<0.05);RA合并感染组和RA活动期组患者血浆sCD14-ST水平均显著高于RA稳定期组和健康对照组,且RA合并感染组患者血浆sCD14-ST水平更高,差异均有统计学意义(P<0.05);RA合并感染组患者血浆sCD14-ST水平与CRP呈正相关(r=0.362,P<0.05),与临床疾病活动指数(CDAI)无相关性(r=0.103,P>0.05);RA稳定期组、RA活动期组患者CDAI与CRP呈正相关(r=0.306、0.298,P<0.05),与血浆sCD14-ST无关(r=0.059,P>0.05);ROC曲线下面积为0.962(95%CI:0.928～0.983)时血浆sCD14-ST诊断RA合并感染患者具有较好的效能(灵敏度为95.41%,特异度为85.00%),其最佳截断值为317pg/mL。结论血浆sCD14-ST可作为鉴别RA合并感染与RA活动期的一项有效指标,能提高RA合并感染的早期诊断率。

Objective To investigate the diagnostic value and clinical significance of plasma soluble leukocyte differentiation antigen 14 subtype（sCD14-ST）in patients with rheumatoid arthritis（RA）associated with infection.Methods A prospective study was conducted to select 58 stable RA patients（RA stable group）,43 active RA patients（RA active group）and 33 co-infected RA patients（RA co-infected group）admitted to Rheumatology and Immunology Department of Xiangya Second Hospital of Central South University from January to October 2016.At the same time,44 healthy people were selected as healthy control group.To determine the changes of plasma sCD14-ST levels in each group,analyze their correlation with C-reactive protein（CRP）and erythrocyte sedimentation rate,and draw the ROC curve to evaluate the predictive value of plasma sCD14-ST for the prognosis of RA patients with infection.Results The plasma levels of sCD14-ST in RA coinfected group,RA active stage group,RA stable group and healthy control group were 1 428（972-3 606）,246（205-479）,172（121-352）,158（61-306）pg/mL,respectively.There were significant differences in sCD14-ST levels among the four groups（H=56.17,P<0.05）.The plasma levels of sCD14-ST in RA patients with infection and RA patients with active stage were significantly higher than those in RA patients with stable stage and healthy control group.The plasma levels of sCD14-ST in RA patients with infection were higher than those in RA patients with active stage,and the difference was statistically significant（P<0.05）.Serum sCD14-ST level was positively correlated with CRP in RA patients with infection（r=0.362,P<0.05）,and was not correlated with clinical disease activity index（CDAI）in RA patients with infection.CDAI was positively correlated with CRP in stable RA group and active RA group（r=0.306、0.298,P<0.05）,and there was no correlation between CDAI and sCD14-ST in the stable and active RA groups（r=0.059,P>0.05）.When the area under ROC curve was 0.962（95%CI：0.928-0.983）,plasma sCD14-ST had a better efficacy（sensitivity was 95.41%,specificity was 85.00%）in the diagnosis of RA complicated with infection.The best cutoff value was 317 pg/mL.Conclusion Serum sCD14-ST can be used as an effective index to differentiate RA complicated infection from RA active period,and can improve the early diagnosis rate of RA complicated infection.