类风湿关节炎患者血清指标与疾病活动度和骨密度的相关性

Correlations between serum NLR and irisin levels and disease activity and bone density in patients with rheumatoid arthritis

目的探讨血清中性粒细胞与淋巴细胞比值(NLR)及鸢尾素在类风湿关节炎(RA)患者中的表达情况,以及与疾病活动度及骨密度的相关性。方法选取2022年4月至2024年4月陕西省核工业二一五医院收治的123例RA患者作为观察组进行回顾性研究,根据疾病活动度分为低等活动度组(27例)、中度活动度组(58例)以及高等活动度组(38例)。选取50例同期体检的健康成年人作为对照组。观察组中男39例,女84例,年龄(47.49±9.31)岁,体重指数(21.41±1.72)kg/m^(2);对照组中男14例,女36例,年龄(48.02±10.08)岁,体重指数(21.39±1.66)kg/m^(2)。通过血清样本分析NLR和鸢尾素的表达水平,并分析其与疾病活动度及骨密度的相关性。采用独立样本t检验、方差分析、χ^(2)检验、Spearman相关性分析、Pearson相关性分析。结果观察组患者NLR(3.35±0.83)、鸢尾素(195.74±24.39)μg/L,对照组分别为(1.85±0.72)、(258.93±41.84)μg/L,差异均有统计学意义(t=11.179、12.381,均P<0.001)。低等活动度组患者NLR(2.46±0.22)、鸢尾素(213.84±12.27)μg/L,中度活动度组分别为(3.15±0.31)、(195.93±16.98)μg/L,高等活动度组分别为(4.39±0.55)、(184.27±9.14)μg/L,差异均有统计学意义(F=216.474、35.360,均P<0.001)。观察组患者的股骨颈骨密度(0.75±0.12)g/cm^(2)、总髋关节骨密度(0.82±0.11)g/cm^(2)、腰椎骨密度(0.84±0.09)g/cm^(2)、大转子骨密度(0.90±0.18)g/cm^(2),对照组分别为(0.89±0.09)g/cm^(2)、(0.96±0.08)g/cm^(2)、(0.97±0.10)g/cm^(2)、(1.05±0.23)g/cm^(2),差异均有统计学意义(均P<0.05)。采用Spearman相关性分析,血清NLR与疾病活动度存在正相关(r=0.879,P<0.001),血清鸢尾素水平与疾病活动度存在负相关(r=-0.615,P<0.001)。采用Pearson相关性分析,血清NLR与股骨颈、总髋关节、腰椎、大转子骨密度均存在负相关(r=-0.358、-0.366、-0.525、-0.174,均P<0.05),血清鸢尾素水平与股骨颈、总髋关节、腰椎、大转子骨密度均存在正相关(r=0.378、0.430、0.352、0.232,均P<0.05)。结论血清NLR和鸢尾素的异常表达与RA患者的疾病活动度和骨密度密切相关,可以作为评估病情活动程度和预测骨密度的有效生物标志物。

Objective To explore the expression levels of serum neutrophil-to-lymphocyte ratio(NLR)and irisin in patients with rheumatoid arthritis(RA)and their correlations with disease activity and bone density.Methods A total of 123 RA patients admitted to No.215 Hospital of Shaanxi Nuclear Industry from April 2022 to April 2024 were selected as the observation group for a retrospective study.According to the disease activity,they were divided into a low activity group(27 cases),a moderate activity group(58 cases),and a high activity group(38 cases).Additionally,50 healthy adults who underwent physical examination during the same period were selected as the control group.In the observation group,there were 39 males and 84 females,aged(47.49±9.31)years,with a body mass index(BMI)of(21.41±1.72)kg/m^(2).In the control group,there were 14 males and 36 females,aged(48.02±10.08)years,with a body mass index of(21.39±1.66)kg/m^(2).Serum samples were analyzed for NLR and irisin levels,and their correlations with disease activity and bone density were assessed.Independent sample t test,ANOVA,χ^(2)test,Spearman correlation analysis,and Pearson correlation analysis were used.Results The levels of NLR(3.35±0.83)and irisin(195.74±24.39)μg/L in the observation group were higher than those in the control group[(1.85±0.72)and(258.93±41.84)μg/L],with statistically significant differences(t=11.179 and 12.381,both P<0.001).The levels of NLR and irisin were(2.46±0.22)and(213.84±12.27)μg/L in the low activity group,(3.15±0.31)and(195.93±16.98)μg/L in the moderate activity group,(4.39±0.55)and(184.27±9.14)μg/L in the high activity group,with statistically significant differences(F=216.474 and 35.360,both P<0.001).The bone mineral density of femoral neck[(0.75±0.12)g/cm^(2)],total hip joint[(0.82±0.11)g/cm^(2)],lumbar spine[(0.84±0.09)g/cm^(2)],and greater trochanter[(0.90±0.18)g/cm^(2)]in the observation group were lower than those in the control group[(0.89±0.09)g/cm^(2),(0.96±0.08)g/cm^(2),(0.97±0.10)g/cm^(2),and(1.05±0.23)g/cm^(2)],with statistically significant differences(all P<0.05).Spearman correlation analysis showed that serum NLR was positively correlated with disease activity(r=0.879,P<0.001),and serum irisin level was negatively correlated with disease activity(r=-0.615,P<0.001).Pearson correlation analysis showed that serum NLR was negatively correlated with bone mineral density of femoral neck,total hip joint,lumbar spine,and greater trochanter(r=-0.358,-0.366,-0.525,and-0.174,all P<0.05),and serum irisin level was positively correlated with bone mineral density of femoral neck,total hip joint,lumbar spine,and greater trochanter(r=0.378,0.430,0.352,and 0.232,all P<0.05).Conclusion Abnormal expressions of serum NLR and irisin are closely associated with disease activity and bone density in RA patients,and can be used as effective biomarkers to evaluate the disease activity and predict the bone mineral density.