膝关节类风湿性关节炎滑膜组织炎性浸润与感染指标的相关性研究

Study on the Correlation between Inflammatory Infiltration of Synovial Tissue and Infectious Indicators in Rheumatoid Arthritis of Knee

目的:探讨膝关节类风湿性关节炎滑膜组织炎性浸润程度与感染指标的关系,为患者的病情评估及临床诊断提供可靠依据。方法:回顾性分析2015年1月至2020年12月诊治的105例膝关节类风湿性关节炎患者的临床资料。收集患者白细胞(WBC)计数、红细胞沉降率(ESR)、C-反应蛋白(CRP)及降钙素原(PCT)等临床资料。对切除的滑膜组织标本进行组织病理学检查,依据滑膜组织炎性浸润程度评分结果,将患者分为轻症组与重症组,分析两组感染指标的差异,并对有统计学差异的感染指标进行Spearman秩相关分析,用受试者工作特征(ROC)曲线对感染指标判断滑膜组织炎性浸润程度的准确性进行评估。结果:术后患者WBC计数、CRP、PCT水平较术前降低,ESR水平较术前升高,差异均有统计学意义(P<0.05)。轻症组中CRP<30.0mg/L、PCT<13.0ng/mL的患者比例高于重症组,而重症组中CRP≥30.0mg/L、PCT≥13.0ng/mL的患者比例高于轻症组,差异均有统计学意义(P<0.05)。CRP水平与炎性浸润程度正相关(r=0.601,P<0.05),PCT水平与炎性浸润程度正相关(r=0.655,P<0.05)。CRP预测滑膜组织炎性浸润程度的曲线下面积(AUC)为0.747(95%CI为0.649~0.844),PCT预测滑膜组织炎性浸润程度的AUC为0.730(95%CI为0.631~0.830)。结论:CRP和PCT能较好地反映滑膜组织炎性浸润程度,可为膝关节类风湿性关节炎患者的病情评估及临床诊断提供可靠依据。

Objective:To investigate the relationship between the degree of inflammatory infiltration of synovial tissue and infectious indicators in rheumatoid arthritis of knee,also provide reliable evidence for condition assessment and clinical diagnosis of the patients.Methods:The clinical data of 105patients with rheumatoid arthritis of knee treated in hospital between January 2015and December 2020 were retrospectively analyzed.The clinical data,including white blood cell(WBC)count,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and procalcitonin(PCT)were collected in the patients.The excision specimens of synovial tissue were histopathologically examined.The patients were divided into either the mild group or the severe group according to the score of inflammatory infiltration degree of synovial tissue.The differences of infectious indicators between the two groups were analyzed.Spearman rank correlation analysis was performed for infectious indicators with statistical differences.Receiver operating characteristic(ROC)curve was used to evaluate the accuracy of infectious indicators in judging the degree of inflammatory infiltration of synovial tissue.Results:The levels of WBC count,CRP and PCT were decreased after surgery,while the level of ESR was increased,with statistical significance(P<0.05).The proportion of patients with CRP<30.0mg/L and PCT<13.0ng/mL in the mild group was higher than that in the severe group,while the proportion of patients with CRP≥30.0mg/L and PCT≥13.0ng/mL in the severe group was higher than that in the mild group,with statistical significance(P<0.05).The level of CRP was positively correlated with the degree of inflammatory infiltration(r=0.601,P<0.05).The level of PCT was positively correlated with the degree of inflammatory infiltration(r=0.655,P<0.05).The area under the curve(AUC)of CRP in predicting the degree of inflammatory infiltration of synovial tissue was 0.747(95%CI=0.649to 0.844).The AUC of PCT in predicting the degree of inflammatory infiltration of synovial tissue was 0.730(95%CI=0.631to 0.830).Conclusion:CRP and PCT can well reflect the degree of inflammatory infiltration of synovial tissue,providing a reliable basis for condition assessment and clinical diagnosis of the patients with rheumatoid arthritis of knee.