北疆地区类风湿关节炎合并贫血患者血清中Hepc、s-HJV水平与疾病活动的相关性分析

Correlation analysis of serum Hepc,s-HJV,and disease activity in patients with rheumatoid arthritis and anemia in northern Xinjiang area

目的通过检测北疆地区类风湿关节炎合并慢性病贫血(RA-ACD)患者血清铁调素(Hepc)和可溶性铁调素调节蛋白(s-HJV)来探究其在RA-ACD发病过程中起到的作用,并分析Hepc、s-HJV与疾病活动度(DAS28)的关系。方法收集2021年3月至2022年5月新疆医科大学第四附属医院、阿勒泰地区哈萨克医医院、阿勒泰地区人民医院、托里县哈萨克医医院、托里县人民医院的RA-ACD患者120例(RA-ACD组)、RA患者120例(RA组)及健康体检者80例(健康对照组),使用双抗夹心酶联免疫吸附法测定以上三组血清中Hepc、s-HJV、血清铁(SI)、转铁蛋白(Tf)、铁蛋白(SF)、白细胞介素6(IL-6)、C反应蛋白(CRP)、红细胞沉降率(ESR)的水平,并计算出DAS28评分。结果三组Hepc、s-HJV、Hb水平比较,差异有统计学意义(P<0.05)。其中RA-ACD组、RA组Hepc低于对照组,RA-ACD组低于RA组;RA-ACD组、RA组s-HJV高于健康对照组,RA组高于健康对照组;RA-ACD组Hb低于RA组和健康对照组,差异有统计学意义(P<0.05)。三组SI、Tf、SF水平比较,差异有统计学意义(P<0.05)。其中,RA-ACD组、RA组SI低于健康对照组,RA-ACD组高于RA组;RA-ACD组、RA组Tf低于健康对照组;RA-ACD组SF水平低于RA组和健康对照组,差异有统计学意义(P<0.05)。三组IL-6、ESR、CRP水平比较,差异有统计学意义(P<0.05)。RA-ACD组、RA组IL-6、ESR、CRP高于健康对照组;RA-ACD组ESR、CRP、DAS28高于RA组,差异有统计学意义(P<0.05)。相关性分析结果显示,Hepc与IL-6呈正相关(r>0,P<0.05),与DAS28呈负相关(r<0,P<0.05);s-HJV与SI、Tf、IL-6、ESR呈正相关(r>0,P<0.05),与Hb呈负相关(r<0,P<0.05);DAS28与SI、ESR、CRP呈正相关(r>0,P<0.05),与Hb呈负相关(r<0,P<0.05);Hb与SI、SF、ESR、CRP、s-HJV呈负相关(r<0,P<0.05)。结论Hepc和s-HJV参与了RA-ACD疾病发展的过程,s-HJV可能是以代偿性增高的方式逆转炎症因子对Hepc的促表达作用;RA的疾病活动与炎症和贫血的关系密切,炎症水平越高病情越重,合并贫血会加重病情;血清Hepc水平随着DAS28水平的增高而减少,提示Hepc与RA患者的疾病活动度有一定关联。

Objective To detect serum iron regulator(Hepc)and soluble iron regulator protein(s-HJV)in patients with rheumatoid arthritis complicated with chronic anemia(RA-ACD)in northern Xinjiang area,and to explore the role of Hepc and s-HJV in the pathogenesis of RA-ACD,to analyze the relationship between HEPC,S-HJV,and disease activity(DAS28).Methods From March 2021 to May 2022,a total of 120 RA-ACD patients(RA-ACD group),120 RA patients(RA group),and 80 healthy physical examination patients(health control group)were collected from the Fourth Affiliated Hospital of Xinjiang Medical University,Altay Kazakh Medical Hospital,Altay Regional People’s Hospital,Tori Kazakh Medical Hospital,and Tori County People’s Hospital.The levels of serum Hepc,s-HJV,serum iron(SI),transferrin(Tf),ferritin(SF),interleukin 6(IL-6),C-reactive protein(CRP),and erythrocyte settlement rate(ESR)in the above three groups were determined by double-antibody sandwich enzymosorbent immunosorbent assay,and DAS28 score was calculated.Results There were statistically significant differences in Hepc,s-HJV and Hb levels among the three groups(P<0.05).Hepc of RA-ACD and RA groups were lower than that of control group,and RA-ACD group was lower than that of RA group;those of s-HJV in RA-ACD and RA groups were higher than that in healthy control group,and RA group was higher than that in healthy control group;Hb in RA-ACD group was lower than that in RA group and healthy control group,and the differences were statistically significant(P<0.05).There were statistically significant differences in SI,Tf,and SF levels among the three groups(P<0.05).The SI of RA-ACD group and RA group was lower than that of healthy control group,and RA-ACd group was higher than that of RA group;Tf in RA-ACD group and RA group was lower than that in healthy control group;The SF level of RA-ACD group was lower than that of RA group and healthy control group,and the differences were statistically significant(P<0.05).The levels of IL-6,ESR,and CRP among the three groups were statistically significant(P<0.05).IL-6,ESR,and CRP in RA-ACD and RA groups were higher than those in healthy control group,ESR,CRP,and DAS28 in RA-ACD group were higher than those in RA group,and the differences were statistically significant(P<0.05).Correlation analysis showed that Hepc was positively correlated with IL-6(r>0,P<0.05),and negatively correlated with DAS28(r<0,P<0.05).s-HJV was positively correlated with SI,Tf,IL-6,and ESR(r>0,P<0.05),and negatively correlated with Hb(r<0,P<0.05).DAS28 was positively correlated with SI,ESR,and CRP(r>0,P<0.05),and negatively correlated with Hb(r<0,P<0.05).Hb was negatively correlated with SI,SF,ESR,CRP,and s-HJV(r<0,P<0.05).Conclusion Hepc and s-HJV are involved in the progression of RA-ACD disease,and s-HJV may reverse the promoting effect of inflammatory factors on Hepc expression in a compensatory way.The disease activity of RA is closely related to inflammation and anemia.The higher the level of inflammation,the more serious the disease will be,and anemia will aggravate the disease.Serum Hepc level decreased with the increase of DAS28 level,suggesting a certain correlation between Hepc and disease activity in RA patients.