脊柱关节炎患者血清DKK-1、Th17细胞和HLA-B27表达及与疾病活动相关性研究

Expression of serum DKK-1,Th17 cells,HLA-B in patients with spinal arthritis and correlation with disease activity

目的探讨脊柱关节炎(SpA)患者血清Dickkopf-1蛋白(DKK-1)、辅助T细胞17(Th17)细胞、人类白细胞抗原-B27(HLA-B27)表达及与疾病活动相关性。方法选取2017年9月—2019年8月商丘市第一人民医院收治的96例SpA患者作为研究组,同期选取83例类风湿性关节炎(RA)作为对照组。统计两组血清DKK-1、Th17细胞、HLA-B27水平,分析血清各指标与SpA关系,受试者工作曲线(ROC)分析血清各指标单一或联合诊断SpA价值。并根据疾病活动指数28(DAS28)评分将研究组划分为病情缓解(n=41,DAS28评分<2.6)及病情活动(n=55,DAS28评分≥2.6)患者,比较血清DKK-1、Th17细胞、HLA-B27水平、疼痛指数(VAS)、医生对患者健康状况总体评估(PHGA),Pearson分析血清各指标与DAS28、VAS、PHGA评分相关性。结果研究组血清DKK-1、Th17细胞、HLA-B27水平高于对照组(P<0.05);Logistic回归分析模型显示,血清DKK-1、Th17细胞、HLA-B27水平与SpA形成密切相关(P<0.05);ROC显示,血DKK-1、Th17细胞、HLA-B27水平联合诊断SpA价值优于单一诊断,AUC为0.899(95%CI:0.845~0.939),敏感度及特异度分别为72.92%、93.98%;研究组病情缓解患者血清DKK-1、Th17细胞、HLA-B27水平及PHGA、VAS评分低于病情活动患者(P<0.05);SpA患者血清Th17细胞、DKK-1、HLA-B27水平与DAS28、VAS、PHGA评分呈正相关(P<0.05)。结论血清DKK-1、Th17细胞、HLA-B27在SpA患者呈异常表达,与疾病活动度、疼痛程度密切相关,可用于早期预警及病情评估,为临床选取合理治疗措施提供依据。

Objective To investigate the expression of Dickkopf-1 protein(DKK-1),helper T cell 17(Th17)cells,human leukocyte antigen-B27(HLA-B27)in patients with spinal arthritis(SpA)and their correlation with disease activity.Methods A total of 96 SpA patients admitted to our hospital from September 2017 to August 2019 were selected as the study group,and 83 rheumatoid arthritis(RA)were selected as the control group.Count the serum DKK-1,Th17 cells,and HLA-B27 levels in the two groups,and analyze the relationship between serum indicators and SpA,the receiver operating curve(ROC)was used to analyze the single or combined diagnosis of SpA in serum.According to the disease activity index 28(DAS28)score,the study group was divided into patients with disease remission(n=41,DAS28 score<2.6)and disease activity(n=55,DAS28 score≥2.6),compare serum DKK-1,Th17 cells,HLA-B27 levels,pain index(VAS),and doctor’s overall assessment of patient health(PHGA),Pearson analysis of the correlation between serum indicators and DAS28,VAS,PHGA scores.Results The levels of serum DKK-1,Th17 cells and HLA-B27 in the study group were higher than those in the control group(P<0.05);Logistic regression analysis model showed that serum DKK-1,Th17 cells,HLA-B27 levels were closely related to SpA formation(P<0.05);ROC showed that the combined diagnosis of SpA with blood DKK-1,Th17 cells,and HLA-B27 levels was superior to single diagnosis,with an AUC of 0.899(95%CI:0.845~0.939),the sensitivity and specificity are 72.92%and 93.98%respectively;Serum DKK-1,Th17 cells,HLA-B27 levels,PHGA,and VAS scores of patients with remission in the study group were lower than those with disease activity(P<0.05);SpA patients’serum Th17 cells,DKK-1,HLA-B27 levels were positively correlated with DAS28,VAS,and PHGA scores(P<0.05).Conclusion Serum DKK-1,Th17 cells,and HLA-B27 are abnormally expressed in SpA patients,and are closely related to disease activity and pain.They can be used for early warning and disease assessment,and provide a basis for clinically selecting reasonable treatment measures.