多基因自身炎症性疾病中降钙素原的表达情况

Expression of procalcitonin in polygenic auto-inflammatory diseases

目的探讨多基因自身炎症性疾病[AOSD、幼年特发性关节炎全身型(sJIA)、炎性肠病性关节炎]中降钙素原(PCT)的水平,并探讨ESR,CRP及ESR/CRP的值与该类疾病及其合并感染的关系。方法收集既往完善PCT检测的自身炎性疾病患者88例,其中AOSD 32例、sJIA 27例、炎性肠病29例,对照组为健康对照30名、SLE 35例。运用电化学发光法监测各组血清PCT的数值,并分别用ESR仪法及免疫比浊法检测各患者ESR及CRP水平,各组之间数据采用matlab软件进行编程筛选,并使用单因素方差分析对各组间样本PCT之间的差异进行比较。结果①在非合并感染的情况下,自身炎症性疾病组PCT数值[(0.36±0.74)μg/L,95%CI(0.174 9,0.550 9)μg/L]较健康对照组[(0.06±0.06)μg/L,95%CI(0.035 1,0.081 7)μg/L]明显升高,差异有统计学意义(F=5.03,P=0.027 4),而与SLE组[(0.45±0.72)μg/L,95%CI(0.3942,1.1592)μg/L]相比,差异无统计学意义(F=1.03,P=0.4755);②在无感染的炎性肠病性关节炎[(0.20±0.32)μg/L,95%CI(0.042 7,0.364 3)μg/L]与健康组PCT对比,差异有统计学意义(F=5.77,P=0.020 4),与SLE组PCT对比,差异无统计学意义(F=0.22,P=0.647 6);在无感染的AOSD[(0.60±1.02)μg/L,95%CI(0.048 4,1.153 6)μg/L]PCT数值与健康组对比,差异有统计学意义(F=7.22,P=0.01),与SLE组PCT对比,差异无统计学意义(F=2.65,P=0.114 3);在无感染的sJIA[(1.52±2.02)μg/L,95%CI (0.054 8,4.591 9)μg/L]中PCT与健康组对比,差异有统计学意义(F=2.23,P<0.01),与非感染SLE组PCT做对比,差异有计学意义(F=8.34,P=0.004 7)。③在自身炎症性疾病未合并感染的情况下,ESR/CRP比值的95%CI(1.121 2,3.589 4);而合并感染的情况下,ESR/CRP的比值95%CI(1.502 2,8.718 8),故考虑ESR/CRP比值在>3.5的情况下可考虑自身炎症性疾病合并感染可能性大。结论①在自身炎症性疾病中即使在不合并感染的情况下仍有PCT高于健康人的现象。②在炎性肠病性关节炎、AOSD、sJIA中PCT的值均明显高于健康对照组,部分高于SLE组,其中,sJIA升高最为明显,其次为AOSD,再者为炎性肠病。③在自身炎症性疾病中,ESR/CRP的比值>3.5对自身炎症性疾病可能合并感染可能具有较高的提示价值,有待进一步研究证实。

Objective To detect the levels of procalcitonin in multiple genes autoinflammatory disease (adult Still disease, systemic juvenile idiopathic arthritis, crohn's Crohn's disease), and to explore the relationship between erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ESR/CRP and disease or complicated infection combined disease. Methods One hundred and fifty-three patients were en-rolled, 88 patients with multiple genes autoinflammatory disease, including 32 cases of adult Still disease, 27 cases of systemic juvenile idiopathic arthritis, 29 cases of Crohn's disease. In addition, 30 cases of healthy controls, 35 patients with systemic lupus erythematosus (SLE) were included into this study. Electroche-miluminescence was used to test the value of serum PCT, erythrocyte sedimentation rate was tested by blood sedimentation instrument method, the CRP level was tested by lmmunoturbidimetry, and the data was handed managed and analysised by matlab software and One-way analysis of variance (ANOVA) was used to compare the differences of PCTs between groups. Results ① In the non-infection condition, the PCT value of the autoimmune inflammatory diseases [(0.36±0.74)μg/L, 95%confidence interval(CI)(0.174 9, 0.550 9)μg/L)] was significantly higher than that of the healthy control group [(0.06±0.06)μg/L, 95%CI(0.035 1, 0.081 7 μg/L)], the difference was statistically significant (F=5.03, P=0.027 4), but there was no statistically significant (F=1.03, P=0.475 5) when comparing with SLE group.② The PCT level of the non-infected inflammatory enteric arthritis [(0.20±0.32), 95%CI(0.042 7, 0.364 3)μg/L] was different compared with the healthy group, the difference was statistically significant (F=5.77, P=0.020 4), at the same time, the difference was not statistically significant when comparing with the SLE group (F=0.22, P=0.647 6). When the PCT value in non-infected adults Still disease [(0.60±1.02) 95%CI(0.048 4, 1.153 6)μg/L] compared with the healthy group, the difference was statistically significant (F=7.22, P=0.01) but the difference was not statistically different when compared with the SLE group (F=2.65, P=0.114 3). The PCT level difference was statistically significant (F=2.23, P<0.01) when comparing infection-free juvenile idiopathic arthritis [(1.52±2.02)μg/L, 95%CI(0.054 8, 4.591 9)μg/L] and the healthy group, the difference was statistically significantly different (F=8.34, P=0.004 7) when com- pared with the PCT of the non-infected SLE group.③ In the case of autoinflammatory diseases without infection, the 95%CI of ESR/CRP ratio was between 1.121 2 and 3.589 4. In the case of co-infection, the 95%CI of ESR/CRP ratio was between 1.502 2 and 8.718 8, so we considered autoimmune inflammatory diseases might had a high possibility of co-infection when the ESR/CRP ratio was higher than 3.5. Conclusion ① The multiple genes autoinflammatory disease group has a higher value of PCT level than healthy controls even without infection.② The mean and 95%CI range of PCT of the inflammatory bowel disease arthritis,adult Still disease and the juvenile id-iopathic arthritis is significantly higher than the healthy controls, partially higher than SLE group. In addition, the PCT level in the juvenile idiopathic arthritis is the highest.③ In clinical, to estimate whether the multiple genes autoinflammatory disease has bacterial infection, we can't just simply rely on PCT to estimate whether the multiple genes autoinflammatory disease has bacterial infection, we may consider the ratio of the ESR/CRP, when the value is higher than 3.5, we may consider patients has strong probability with infection.