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李峰, 万磊, 闫大伟, 等. 白介素6、白介素12P70、血清淀粉样蛋白酶A和降钙素原对类风湿关节炎的诊断价值及与疾病活动度的关系[J]. 四川大学学报（医学版）, 2024, 55(4): 995-1000. DOI: 10.12182/20240760107
引用本文: 李峰, 万磊, 闫大伟, 等. 白介素6、白介素12P70、血清淀粉样蛋白酶A和降钙素原对类风湿关节炎的诊断价值及与疾病活动度的关系[J]. 四川大学学报（医学版）, 2024, 55(4): 995-1000. DOI: 10.12182/20240760107
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LI Feng, WAN Lei, YAN Dawei, et al. Diagnostic Value of Interleukin 6, Interleukin 12P70, Serum Amyloid A, and Procalcitonin for Rheumatoid Arthritis and Their Relationship With the Disease Activity[J]. Journal of Sichuan University (Medical Sciences), 2024, 55(4): 995-1000. DOI: 10.12182/20240760107
Citation: LI Feng, WAN Lei, YAN Dawei, et al. Diagnostic Value of Interleukin 6, Interleukin 12P70, Serum Amyloid A, and Procalcitonin for Rheumatoid Arthritis and Their Relationship With the Disease Activity[J]. Journal of Sichuan University (Medical Sciences), 2024, 55(4): 995-1000. DOI: 10.12182/20240760107
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白介素6、白介素12P70、血清淀粉样蛋白酶A和降钙素原对类风湿关节炎的诊断价值及与疾病活动度的关系

Diagnostic Value of Interleukin 6, Interleukin 12P70, Serum Amyloid A, and Procalcitonin for Rheumatoid Arthritis and Their Relationship With the Disease Activity

    摘要
  • 摘要:
    目的 观察血清炎症四项〔白介素6（interleukin 6, IL-6）、白介素12P70（interleukin 12P70, IL-12P70）、血清淀粉样蛋白酶A（serum amyloid A, SAA）和降钙素原（procalcitoninogen, PCT）〕对类风湿关节炎（rheumatoid arthritis, RA）的诊断价值，并分析其与疾病活动度的关系。
    方法 纳入2022年12月–2023年12月安徽省中医院风湿科住院的RA患者60例，以同期安徽省中医院体检中心的正常体检者30例为对照组。采用流式细胞术检测血清IL-6和IL-12P70，采用免疫比浊法测定SAA，采用化学发光法测定血清PCT。采用全自动生化分析仪检测血沉（erythrocyte sedimentation rate, ESR）、C反应蛋白（C-reactive protein, CRP）、类风湿因子（rheumatoid factor, RF）和抗环瓜氨酸肽（anticyclic citrullinated peptide, ACCP）。计算基于ESR的28个关节疾病活动评分（DAS28-ESR）。采用t检验、秩和检验和Kruskal Wallis H检验分析炎症四项在不同组间的表达差异，ROC曲线分析炎症四项对RA的诊断价值，Spearman相关性分析比较炎症四项与CRP、ESR、RF、ACCP和DAS28-ESR之间的相关性。
    结果 ①RA组的SAA、IL-6和IL-12P70表达水平均比对照组表达水平高（P<0.01）。②ROC曲线结果显示，RA组与对照组相比PCT的ROC曲线下面积（area under the curve, AUC）为0.611〔95%置信区间（confidence interval, CI）：0.488～0.735，P>0.05〕；SAA的AUC为0.819（95%CI：0.733～0.906，P<0.01）；IL-6的AUC为0.875（95%CI：0.803～0.946，P<0.01）；IL-12P70的AUC为0.832（95%CI：0.746～0.917，P<0.01）；IL-6+IL-12P70+SAA+PCT联合指标的AUC为0.973（95%CI：0.942～1.000，P<0.01）。③PCT、SAA在RA高活动组、中活动组、低活动组3组中的表达水平不同（P<0.01）。④RA组患者中CRP与SAA（rs=0.75，P<0.01）和IL-6呈正相关（rs=0.52，P<0.01），ESR与SAA（rs=0.36，P<0.01）呈正相关，DAS28-ESR与PCT（rs=0.34，P=0.01）、SAA（rs=0.51，P<0.01）和IL-6呈正相关（rs=0.33，P=0.01）。
    结论 炎症四项（PCT、SAA、IL-6和IL-12P70）与RA疾病活动度关系密切，可作为协助诊断RA及评估RA疾病活动度的血清指标之一。

     

    Abstract:
    Objective To observe the diagnostic value of four serum inflammatory biomarkers, including interleukin 6 (IL-6), interleukin 12P70 (IL-12P70), serum amyloid A (SAA), and procalcitonin (PCT), in rheumatoid arthritis (RA) and to analyze their relationship with the disease activity.
    Methods The study included 60 RA patients admitted to the Department of Rheumatology at Anhui Provincial Hospital of Traditional Chinese Medicine between December 2022 and December 2023. Thirty healthy individuals from the hospital’s physical examination center served as the control group. Serum levels of IL-6 and IL-12P70 were detected using flow cytometry. SAA levels were determined by immunoturbidimetry, and PCT levels were assessed by chemiluminescence. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), and anticyclic citrullinated peptide (ACCP) were detected using an automated biochemical analyzer. The 28-joint disease activity scores (DAS28-ESR) based on ESR were observed. Statistical analysis included t-tests, rank-sum tests, and Kruskal-Wallis H tests to compare the expression differences of the biomarkers among different groups. The diagnostic value of these biomarkers for RA was analyzed by ROC curve analysis. Spearman correlation analysis was performed to assess the relationships between the four inflammatory biomarkers and CRP, ESR, RF, ACCP, and DAS28-ESR.
    Results 1) The expression levels of SAA, IL-6, and IL-12P70 in the RA group were significantly higher than those in the control group (P<0.01). 2) ROC curve analysis showed that the area under the curve (AUC) for PCT was 0.611 (95% confidence interval CI: 0.488-0.735, P>0.05), for SAA, it was 0.819 (95% CI: 0.733-0.906, P<0.01), for IL-6, it was 0.875 (95% CI: 0.803-0.946, P<0.01), and for IL-12P70, it was 0.832 (95% CI: 0.746-0.917, P<0.01). The combined index of IL-6, IL-12P70, SAA, and PCT had an AUC of 0.973 (95% CI: 0.942-1.000, P<0.01). This indicates that the four inflammatory biomarkers can assist in the diagnosis of rheumatoid arthritis. 3) The expression levels of PCT and SAA varied significantly among the high, moderate, and low activity RA groups (P<0.01). 4) In RA patients, CRP was positively correlated with SAA (rs=0.75, P<0.01), and IL-6 (rs=0.52, P<0.01). ESR was positively correlated with SAA (rs=0.36, P<0.01). DAS28-ESR was positively correlated with PCT (rs=0.34, P=0.01), SAA (rs=0.51, P<0.01) and IL-6 (rs=0.33, P=0.01).
    Conclusion The four inflammatory biomarkers (PCT, SAA, IL-6, and IL-12P70) are closely related to rheumatoid arthritis disease activity and can serve as serum indicators to assist in the diagnosis and assessment of RA.

     

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