Correlation analysis of serum HE4 and PS-PLA1 expression with disease activity and disease outcome in patients with rheumatoid arthritis
蒋磊 1方兴刚 1兰培敏 1陈汉玉1
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作者信息
1. 湖北省十堰市太和医院,湖北医药学院附属医院中西医结合科,442000
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摘要
目的:探讨类风湿关节炎(RA)病人血清人附睾蛋白4(HE4)、磷脂酰丝氨酸特异性磷脂酶A1(PS-PLA1)表达水平与疾病活动度、疾病转归的相关性.方法:选择活动期RA病人112例作为RA组,根据28处关节疾病活动度(DAS28)评分分为低度活动组、中度活动组和高度活动组.另选取同期健康体检人员110名作为对照组.采用化学发光法检测血清HE4水平,ELISA法检测血清PS-PLA1水平,收集病人一般资料及血清指标水平,Pearson法分析RA病人血清HE4、PS-PLA1与临床指标的相关性,Spearman法分析血清HE4、PS-PLA1与转归的相关性,ROC曲线分析HE4、PS-PLA1对RA的诊断价值.结果:与对照组比较,RA组病人红细胞沉降率、血清C反应蛋白、类风湿因子、抗环瓜氨酸肽抗体、HE4、PS-PLA1水平明显升高(P＜0.01).与低度活动组比较,中度活动组、高度活动组病人血清HE4、PS-PLA1水平升高(P＜0.05);与中度活动组比较,高度活动组病人血清HE4、PS-PLA1水平升高(P＜0.05).血清HE4诊断RA的AUC为0.851(95％CI:0.797～0.895),敏感度为76.79％,特异度为 82.73％;PS-PLA1 诊断 RA 的 AUC 为 0.818(95％CI:0.761～0.866),敏感度为 77.68％,特异度为72.73％;HE4、PS-PLA1 联合诊断 RA 的 AUC 为 0.903(95％CI:0.856～0.939),敏感度为 86.61％,特异度为 83.64％.与治疗前比较,治疗后血清HE4、PS-PLA1水平明显降低,晨僵时间、关节压痛数明显减少,VAS评分、DAS28评分明显降低(P＜0.01).相关分析显示,RA病人血清HE4、PS-PLA1水平与红细胞沉降率、血清C反应蛋白、类风湿因子、抗环瓜氨酸肽抗体、DAS28评分及转归均呈明显正相关关系(P＜0.01).结论:RA病人血清HE4、PS-PLA1水平升高,与RA疾病活动程度及病人转归有关,在临床上对RA诊断、病情评估及转归评价有一定参考价值.
Abstract
Objective:To investigate the correlation of serum human epididymal protein 4(HE4)and phosphatidylserine-specific phospholipase A1(PS-PLA1)expression levels with disease activity and disease outcome in patients with rheumatoid arthritis(RA).Methods:A total of 112 active RA patients were selected as the RA group,and divided into low activity group,moderate activity group and high activity group according to the disease activity score 28-joints(DAS28).In addition,110 healthy examinees were taken as the control group.Chemiluminescence was used to detect the level of serum HE4,ELISA was applied to detect the level of serum PS-PLA1,the general information and serum index levels of the patients were collected,Pearson method was used to analyze the correlation between serum HE4,PS-PLA1 and clinical indicators in RA patients,Spearman method was used to analyze the correlation between serum HE4,PS-PLA1 and outcome,and ROC curve was used to analyze the diagnostic value of HE4 and PS-PLA1 in RA.Results:Compared with the control group,the erythrocyte sedimentation rate,serum C-reactive protein,rheumatoid factor,anti-cyclic citrullinated peptide antibody,HE4 and PS-PLA1 of patients in the RA group were obviously increased(P＜0.01).Compared with the low activity group,the levels of serum HE4 and PS-PLA1 in the moderate activity group and high activity group were increased(P＜0.05);compared with the moderate activity group,the levels of serum HE4 and PS-PLA1 in the high activity group were increased(P＜0.05).The area under the curve(AUC)of serum HE4 for diagnosing RA was 0.851(95％CI:0.797-0.895),with a sensitivity of 76.79％and a specificity of 82.73％;the AUC of PS-PLA1 in diagnosing RA was 0.818(95％CI:0.761-0.866),with a sensitivity of 77.68％and a specificity of 72.73％;the AUC of HE4 combined with PS-PLA1 diagnosis for RA was 0.903(95％CI:0.856-0.939),with a sensitivity of 86.61％and a specificity of 83.64％.Compared with before treatment,the levels of serum HE4 and PS-PLA1 were obviously decreased,the morning stiffness time and joint tenderness were obviously decreased,the VAS score and DAS28 score were obviously decreased after treatment(P＜0.01).Correlation analysis showed that the levels of serum HE4 and PS-PLA1 in RA patients were significantly positively correlated with erythrocyte sedimentation rate(ESR),serum C-reactive protein(CRP),rheumatoid factor(RF),anti-cyclic citrullinated peptide(CCP)antibody,DAS28 score and outcome(P＜0.01).Conclusions:Serum HE4 and PS-PLA1 levels in RA patients are elevated,which are related to the degree of RA disease activity and outcome,and have certain reference values for RA diagnosis,disease evaluation,and outcome evaluation.
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