肝素结合蛋白在鉴别诊断类风湿性关节炎合并细菌感染患者中的临床价值

Clinical value of heparin-binding protein in differentiating patients with rheumatoid arthritis complicated by bacterial infection

目的探讨血浆肝素结合蛋白(HBP)在类风湿性关节炎(RA)合并细菌感染患者中的诊断价值和临床意义。方法纳入RA患者122例、单纯细菌感染患者23例、同期健康体检者60例作为研究对象,其中RA合并细菌感染组42例,RA活动期组39例,RA缓解期组41例。应用透射免疫比浊法测定研究对象静脉血HBP浓度,评估其与白细胞(WBC)、红细胞沉降速率(ESR)、C反应蛋白(CRP)的相关性。不同组间比较采用Kruskal-Wallis H检验,使用Spearman做连续变量相关性分析,绘制受试者工作特征曲线(ROC),评估HBP鉴别诊断RA患者合并细菌感染的敏感性和特异性。结果RA合并细菌感染组HBP为63.30(36.83~123.00)ng/mL,高于RA活动期组17.00(14.00~21.60)ng/mL(P<0.01),高于RA缓解期组8.30(6.65~9.60)ng/mL(P<0.01)和健康对照组7.40(5.63~8.80)ng/mL(P<0.01),与单纯细菌感染组68.70(42.10~100.60)ng/mL比较差异无统计学意义(P>0.05);RA活动期组高于RA缓解期组(P<0.01)和健康对照组(P<0.01);RA缓解期组和健康对照组无统计学差异(P>0.05)。RA合并细菌感染组HBP水平与CRP呈正相关(r=0.332,P<0.05),RA活动期组HBP水平与CRP、疾病活动度(DAS28)呈正相关(r=0.582,P<0.01;r=0.461,P<0.05),两组HBP水平与WBC、ESR均无相关性(P>0.05)。ROC曲线显示当HBP水平为24.55 ng/mL时,是诊断RA患者合并细菌感染的最佳阈值,其敏感性为92.9%,特异性为84.6%。结论HBP是可用于RA合并细菌感染和活动期鉴别诊断的敏感且特异的指标。

Objective To investigate the diagnostic value and clinical significance of plasma heparin-binding protein(HBP)in patients with rheumatoid arthritis(RA)complicated by bacterial infection.Methods A total of 122 RA patients,23 patients with simple bacterial infection,and 60 healthy people who underwent physical examination during the same period were included as the research subjects,including 42 patients with RA complicated with bacterial infection,39 patients in the active RA group,and 41 patients in the RA remission group.The concentration of HBP in venous blood was measured by transmission immunoturbidimetric assay,and its correlation with white blood cells(WBC),erythrocyte sedimentation rate(ESR),and C-reactive protein(CRP)was evaluated.The Kruskal-Wallis H test was used for comparison between different groups,and Spearman for continuous variable correlation analysis;and then the receiver operating characteristic(ROC)curve was drawn to evaluate the sensitivity and specificity of HBP in the differential diagnosis of RA patients with bacterial infection.Results The HBP in the group of RA complicated with bacterial infection was 63.3(36.83~123)ng/mL,higher than 17(14~21.6)ng/mL(P<0.01)in the active RA group,8.3(6.65~9.6)ng/mL(P<0.01)in the RA remission group,and 7.4(5.63~8.8)ng/mL(P<0.01)in the healthy control group,compared with 68.70(42.10~100.60)ng/mL in the simple bacterial infection group,there was no significant difference(P>0.05).The active RA group had higher HBP than the RA remission group(P<0.01)and the healthy control group(P<0.01),there being no statistical difference between the RA remission group and the healthy control group(P>0.05).The level of HBP in the group of RA complicated with bacterial infection was positively correlated with CRP(r=0.332,P<0.05),and the level of HBP in active RA group was positively correlated with CRP and disease activity(DAS28)(r=0.582,P<0.01;r=0.461,P<0.05),with no correlation in the levels of HBP and WBC and ESR between the two groups(P>0.05).The ROC curve showed that when the HBP level was 24.55 ng/mL,it was the best threshold for diagnosing bacterial infection in RA patients,with a sensitivity of 92.9%and a specificity of 84.6%.Conclusion HBP could be a sensitive and specific index for the differential diagnosis of RA complicated with bacterial infection and at the active stage.