类风湿关节炎患者血浆FDP和DD水平与疾病活动性的相关性研究

Correlation between Plasma FDP, DD Levels and Disease Activity in Patients with Rheumatoid Arthritis

目的探讨类风湿关节炎(RA)患者血浆中纤维蛋白(原)降解产物(FDP)和D-二聚体(DD)水平与疾病活动性的相关性。方法选择2018年1~12月在四川省骨科医院住院并诊断为RA的患者71例,并收集患者的临床资料。根据DAS28评分将RA患者分为病情稳定组(DAS28≤2.6分)和病情活动组(DAS28>2.6分)。收集同期体检者65例作为对照组,检测FDP,DD,类风湿因子(RF)、抗环瓜氨酸肽(CCP)抗体、补体3(C3)、补体4(C4)、红细胞沉降率(ESR)和C-反应蛋白(CRP)水平。比较两组FDP和DD水平,分析FDP,DD与其他指标的相关性,并对FDP,DD单独和联合诊断RA的受试者工作(ROC)曲线分析,探讨FDP,DD与RA患者病情活动性的相关性。结果 RA患者组FDP,DD水平高于对照组(U=520,741,均P <0.05),且病情活动组FDP,DD,ESR,CRP,C3和DAS28评分均高于稳定组,差异有统计学意义(U=26,P<0.001;U=58,P<0.001;t=6.273,P <0.001;U=146.5,P <0.001;t=2.047,P=0.0452;t=9.90,P <0.001)。RA患者血浆中FDP水平与DAS28评分、CRP,ESR均呈正相关性(r=0.861 1,0.642 1,0.704 9,均P <0.05);DD与DAS28评分、RF,CRP,ESR,C3均呈正相关性(r=0.844,0.383 2,0.693 1,0.640 2,0.257 5,均P <0.05)。根据ROC曲线,FDP和DD单独检测诊断RA的曲线下面积(AUC)分别为0.839 4和0.862,敏感度和特异度分别为95.38%,69.01%和92.65%,75.04%,两者联合检测诊断RA的AUC为0.887 3,敏感度和特异度分别为96.92%,76.06%。结论 RA患者FDP,DD水平显著升高并与疾病活动度相关,且两项指标联合检测可作为监测RA疾病活动度的参考指标。

Objective To explore the correlation between fibrinogen(proto) products(FDP), D-dimer(DD) levels of plasma and disease activity in patients with rheumatoid arthritis(RA). Methods A total of 71 patients admitted to Sichuan Provincial Orthopedic Hospital from January to December 2018 and diagnosed with RA were enrolled, and clinical data were collected. According to the DAS28 score, RA patients were divided into stable group(DAS28 ≤ 2.6) and activity group(DAS28>2.6). Meanwhile,65 cases normal person were selected as the controls group. Detection of FDP, DD, rheumatoid factor(RF), anticyclic citrullinated peptide(CCP) antibodies, complement 3(C3), complement 4(C4), erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) levels. To compare the level of FDP and DD and the correlation between FDP, DD and other indicators. The receiver operating characteristics(ROC) curves of FDP and DD alone and in combination in RA patients. Results The FDP and DD values of patients with RA were significantly higher than those of healthy controls(U=520,741,all P<0.05). The active group FDP, DD, ESR,CRP, C3 and DAS28 levels were significantly higher than the stable group(U=26,P<0.001;U=58, P<0.001;t=6.273, P<0.001;U=146.5, P< 0.001;t=2.047,P=0.0452;t=9.90, P<0.001). The FDP level was positive correlation with DAS28, CRP and ESR(r=0.861 1, 0.642 1, 0.704 9,all P<0.05). DD showed a significant positive correlation with DAS28, RF, CRP, ESR and C3(r=0.844, 0.383 2, 0.693 1, 0.640 2, 0.257 5, all P< 0.05).The AUC of FDP and DD in the diagnosis of RA was 0.839 4 and 0.862, respectively,the sensitivity and specificity were 95.38%,69.01% and 92.65%,75.04%,respectivery. The AUC of combined detection of FDP and DD in the diagnosis of RA was 0.887,the sensitivity and specificity was 96.92% and 76.06%,respectively. Conclusion FDP and DD in RA patients were significantly increased and correlated with the activity of the disease, and joint detection of two indicators can be used as a reference for monitoring RA activities.