血清信号素3A在类风湿关节炎的诊断价值

The Diagnostic Value of Serum Semaphorin3A in Rheumatoid Rrthritis

目的通过检测血清信号素3A(Sema3A)在类风湿关节炎(RA)中的表达水平,探讨其对RA的诊断价值。方法随机选取到赣州市人民医院就诊者并分为三组:(1)RA组(病情活动性RA 51例,病情非活动性RA 52例)。(2)非RA组患者93例。(3)健康对照组(HC)50例。采用酶联免疫吸附法(ELISA)检测血清中Sema3A、抗环瓜氨酸多肽抗体(anti-CCP)和抗RA33抗体(anti-RA33);散射比浊法检测类风湿因子(RF)和C-反应蛋白(CRP);魏氏法检测红细胞沉降率(ESR)。结果RA组血清Sema3A、anti-CCP、RF和anti-RA33表达水平分别为(27.15±8.19)ng/ml、131.31(399.50)U/ml、105.90(167.50)U/ml和30.80(23.80)U/ml,与非RA组和HC组比较,结果具有统计学差异。Sema3A对RA诊断的曲线下面积为0.76,标准误为0.03,95%可信区间(95%CI)为0.70~0.82。ROC曲线分析各项指标对RA的诊断显示,特异度最高的是anti-CCP(Sp=0.92),灵敏度最高的是RF(Se=0.83),约登指数和曲线下面积最高的是anti-CCP(YDI=0.73,AUC=0.85)。RA病情活动组和非活动组血清Sema3A水平比较具有统计学差异(P<0.01),血清Sema3A与ESR、CRP、DAS28均呈负相关(r=-0.54,r=-0.66,r=-0.42,P<0.01)。结论Sema3A对RA患者具有良好诊断价值,与非RA患者比较具有鉴别诊断价值,且可以用来判断RA疾病的严重程度。

Objective To investigate the level of Semaphorin3A(Sema3A)and its,diagnostic value in rheumatoid arthritis(RA).Methods 103 RA patients,93 non-RA patients and 50 healthy controls(HC)were randomly selected from Ganzhou People's Hospital.Sema3A,anticyclic citrulline polypeptide antibody(anti-CCP)and antibody RA33(anti-RA33)were detected by ELISA,Rheumatoid factor(RF)and C-reactive protein(CRP)were detected by latex immunoturbidimetric assay,Erythrocyte sedimentation rate(ESR)was measured by the Wei's method.Results Serum expression levels of Sema3A,anti-CCP,RF,and anti-RA33 in the RA group were(27.15±8.19)ng/ml,131.31(399.50)U/ml,105.90(167.50)U/ml and 30.80(23.80)U/ml,which were statistically different when compared with the non-RA and HC groups(P<0.05).The area under the curve for RA diagnosis was 0.76,a standard error of 0.03 and a 95%CI of 0.70 to 0.82.The ROC curve was drawn to analyze the diagnostic indicators.The highest specificity was anti-CCP(Sp=0.92),the highest sensitivity was RF(Se=0.71),and the Youden index and the area below the curve were anti-CCP(YDI=0.78,AUC=0.92).The serum Sema3A levels of active and inactive RA were statistically different(P<0.01),and was negatively associated with ESR,CRP and DAS28(r=-0.54,r=-0.66,r=-0.42,P<0.01).Conclusions The expression level of Sema 3A in the serum is not only significantly elevated in the patients with RA,but also can be used to determine the severity of RA disease.