C反应蛋白/白蛋白、白蛋白/纤维蛋白原在类风湿性关节炎中的应用价值

Value of C-reactive Protein/Albumin and Albumin/Fibrinogen in Patients with Rheumatoid Arthritis

目的:探讨C反应蛋白/白蛋白(CAR)、白蛋白/纤维蛋白原(AFR)在类风湿性关节炎(RA)中的变化及临床意义。方法:选取2018年5月—2022年4月广州市花都区妇幼保健院就诊的106例RA患者作为疾病组、62例骨关节痛患者作为疾病对照组及110例体检健康人群作为健康对照组进行回顾性分析,对比临床特征及实验室检测指标。疾病组患者采用28处关节疾病活动度评估(DAS28)进行疾病活动度评分。比较三组受试者间肿瘤坏死因子-α(TNF-α)、白介素6(IL-6)、CAR及AFR的差异,用Spearman相关分析RA患者DAS28评分与实验室指标的相关性,通过logistics回归评价RA发生的独立危险因素,并通过ROC曲线分析独立危险因素对RA的诊断价值。结果:三组受试者间TNF-α、IL-6、CAR及AFR比较,差异有统计学意义(F=198.973、183.136、182.196、128.232,P<0.001)。疾病组患者CAR显著高于疾病对照组,差异有统计学意义(t=3.070,P=0.003),疾病组患者AFR显著低于疾病对照组,差异有统计学意义(t=2.489,P=0.014),两组患者间TNF-α、IL-6水平比较,差异无统计学意义(t=0.773、1.349,P>0.05)。CAR与DAS28评分呈显著正相关(r=0.754,P<0.001),而AFR与DAS28评分呈显著负相关(r=-0.568,P<0.001)。TNF-α、IL-6与DAS28评分无显著相关性(r=0.178、0.087,P>0.05)。logistic回归分析结果显示,CAR、AFR均是RA发生的独立危险因素。以疾病对照组和健康对照组作为对照组进行ROC曲线分析,CAR的曲线下面积(AUC)为0.855,最佳截断值为0.55,此时对RA的诊断敏感性为100%,特异性为65.12%;AFR的AUC为0.821,截断值为9.31,此时对RA的诊断敏感性为75.47%,特异性为79.07%。结论:CAR及AFR可作为RA发生的独立危险因素,且对RA具有一定的诊断价值。

Objective: To investigate the changes and clinical significance of C-reactive protein to albumin ratio(CAR) and albumin to fibrinogen ratio(AFR) in patients with rheumatoid arthritis(RA). Methods: The clinical characteristics and laboratory indexes were retrospectively analyzed which consisted of 106 patients with RA(case group), 62 patients with osteoarthralgia(case control group) and 110 physical examination healthy people(healthy control group). Subjects were recruit from Guangzhou Huadu District Maternal and children hospital from May 2018 to April 2022. The RA group was scored by DAS28. Tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),CAR and AFR were compared among the three groups. The correlations between DAS28 score and laboratory indexes of RA patients were analyzed by Spearman correlation. The independent risk factors of RA were evaluated by Logistic regression. The value of independent risk factors for diagnosis of RA was analyzed by ROC curve. Results: TNF-α, IL-6, CAR and AFR among three groups were significantly different(F=198.973,F=183.136,182.196,F=128.232;P<0.001). The CAR of the case group was higher than that of the case control group,the difference was statistically significant(t=3.070,P=0.003),and the AFR was lower than that of the case control group,the difference was statistically significant(t=2.489,P=0.014). The differences in TNF-α or IL-6 levels between case group and control group were not statistically significant(t=0.773, t=1.349;P>0.05). CAR was positively correlated with DAS28 score(r=0.754, P<0.001),while AFR was negatively correlated with DAS28 score(r=-0.568,P<0.001). There was no correlation between TNF-α or IL-6 and DAS28 score(r=0.178, r=0.087;P>0.05). Logistic regression analysis showed that CAR and AFR were independent risk factors for the development of RA. Taking the case control group and the healthy control group as control for ROC curve analysis,the AUC of CAR was 0.855. The cut-off value was 0.55. The sensitivity and specificity for RA were 100%and 65.12%,respectively. The AUC of AFR was 0.821. The cut-off value was 9.31. The sensitivity and the specificity for RA were 75.47% and 79.07%,respectively. Conclusion: Both of CAR and AFR can be regarded as independent risk factors of RA activity and have diagnostic value for RA.